COVID-19 YMCA Member Assistance
We know that this time is difficult and we would like to be there for you. Please complete the brief survey so that we can get in touch and help where possible.

If you are in need of child care, please go to: https://www.blackhawkymca.org/covidycare/ to learn about our Emergency Child Care program and register if you qualify.
Email address *
Full Name *
Your answer
Y Facility Location *
Membership Type *
Phone Number
Your answer
How would you like us to contact you?
What do you need for you and your family? *
Your answer
Is there anything the Y can be doing online during this time that would support you or your family? *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Family YMCA of Black Hawk County. Report Abuse