Youth Access Membership – Intake survey

Youth Access Membership - Intake Survey

The following survey is required to maintain your YAP membership. Completion of the survey will allow us to activate your membership for another 6 months.. At the end of that period, you will be required to complete an additional survey to reactivate your membership and so on. After one year of membership, you will need to be re-nominated.

If you have any questions, please connect with us at yap@ymcafredericton.org

Member Information

The following information is regarding the Youth who will have the membership.

Name *

First

Last

Email (the one on your online account) *

What is your ethnicity/culture *

If you selected North American Indigenous Origins, which Indigenous community are you a part of?

If you are a newcomer to Canada, what year did you arrive?

What is your gender identify *

Tick all that apply

Your YMCA Membership

The following information is regarding your YMCA membership and your goals.

Why do you want a YMCA membership? *

What do you plan to do the most with your YMCA Membership? Choose only one. *

If you are thinking about a registered program, what program(s) are you thinking about?

Is there anything in your life that would stop you from coming to the YMCA? (Eg. I don't have proper footwear, no access to transportation, I'm nervous, I need a support person, I am busy, the cost of the programs, etc. *

What are your goal(s) for coming to the YMCA? *

energy? your

How will you know you have reached your goal(s)? *

Quality of Life

The following information is regarding the four quality of life indicators.

Sense of belonging. Do you feel like you are part of your community, school or the places where you spend time? Choose one. *

Very much
Sometimes
Not really
Not at all

Mental Health. How do you feel about your mental health; your feelings and emotions? Choose one. *

Very good
Good
Not so good
Bad

Health. How do you feel about your overall health; your body and energy? Choose one. *

Very healthy
Somewhat healthy
Not very healthy
Not healthy at all

Life Satisfaction How happy are you with your life right now? Choose one. *

Very happy
Somewhat happy
Not very happy
Not happy at all

Thank you for completing this survey. We are honoured to be involved in your wellness journey and know that the identifying information you provided will not be shared outside of the YMCA. The non-identifying information you provided may be used in reports and applications for further funding to provide additional memberships to the youth in our community.
Please contact us with any questions at yap@ymcafredericton.org

By checking "I understand", I acknowledge that I have read and understand the following
statements:
1. By completing this survey I am allowing the Outreach team to activate my Youth Access
membership for one membership term.
2. When this membership expires, I will be required to complete another survey to reactivate my membership for another term.
3. I am prepared to use my membership regularly and complete a check-in survey at the end of every term. I understand that by not using my membership or completing the check-in survey, my membership may not be renewed.
4. I am prepared to abide by the Fredericton YMCA conduct policy.

Please check *

I understand