ACT! Actively Changing Together: Registration Form
ECS in partnership with the Y, will be hosting a 12 week session on Saturdays for families and youth to participate in a healthier living program to promote healthier eating and exercise.
For any questions: 
Teddy Ayele:

Rahel Schwartz:
Sign in to Google to save your progress. Learn more
Parent/ Guardian Name: *
Phone number
How did you hear about the ACT! program? Check all that apply
Have you or your child previously  participated in the ACT program?
Clear selection
If Yes, please specify when and where:
When you signed up for ACT! were you a current YMCA member?
Clear selection
How does your child participating in ACT! identify:
Clear selection
What is your child's age?
Do you think of your child as:
Clear selection
Do you think of yourself as:
Clear selection
What do you most want to get out of the ACT! program?
Other thoughts or comments
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy