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: 
tayele@seattleymca.org

Rahel Schwartz:
rschwartz@seattleymca.org
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Parent/ Guardian Name: *
Phone number
How did you hear about the ACT! program? Check all that apply
Other
Have you or your child previously  participated in the ACT program?
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If Yes, please specify when and where:
When you signed up for ACT! were you a current YMCA member?
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How does your child participating in ACT! identify:
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What is your child's age?
Do you think of your child as:
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Do you think of yourself as:
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What do you most want to get out of the ACT! program?
Other thoughts or comments
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