Senior Health Outreach Request

With the COVID-19 pandemic creating more isolation and loneliness for our communities, the YMCA wants you to know that we are here for you!

If you are an older adult who has struggled over the last few months to maintain your health routines, social connections, or other aspects of your daily life, let us reach out to you to provide support, through a one-time phone call to connect or a weekly check-in.

Fill out this form to receive a call from one of our caring YMCA staff members – whether you’ve already been contacted or not – and we’ll reach out to you within five working days!

Customer Information

Please provide the customer information requested below to help us assist you.

First Name

Last Name

Date of Birth

Phone Number

Email Address

What is the Best Time to Contact You?

YMCA Membership Status

Preferred Language

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For languages other than English or Spanish, we will do our best to fulfill your request.

Home Branch

Please indicate your current home branch. If you don't know, select "Don't Know." YMCA members have access to all Y locations in Greater Seattle.

Home Branch

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