YMCA of Greater New Orleans – New Member Interview & Engagement Form New Member:_________________________________ Team Member:_________________________________ Date:__________/__________/____________ Contact:
In-person
Phone Call
YMCA Goals/Joining History Goals for Joining (check all that apply): Lose Weight
Enroll in Specific Programs
Sports Event Training
Build Relationships
Improve Health
Improve Strength/Muscle Tone
Summer Amenities
Medical Reasons
Other:__________________________
Reasons for Joining the YMCA (over other options): Price
Convenient Location
Friends/Family are Members
Amenities
Prior Member
Family Programs Offered
Discounted Membership
Group Ex Classes
Other:________________________
Additional Comments:_______________________________________________________________________________ __________________________________________________________________________________________________
Action Items/Recommendations: Wellness Orientation Scheduled/Declined:_________________________________________________ Review Classes/Equipment Offered/Schedule – Interested in:__________________________________ Family Programs Offered at the Branch – Interested in:_______________________________________ Nutrition Tips & Resources (foods that are good, foods to avoid - www.choosemyplate.gov) Non-profit Mission of the YMCA
Director Welcome Letter Sent
Staff Referrals – Staff Member/Action:____________________________________________________ Staff Member/Action:_____________________________________________________ Staff Member/Action:_____________________________________________________ 30 to 60 Day Follow-up/Survey:_______________________________________________________________________ __________________________________________________________________________________________________
New Member Engagement Form - Updated 1/8/2015