Change OhioHealth Membership

Your Name *

First Name Last Name

OhioHealth Clock Number *

Eligibility? *

Any OhioHealth associate is eligible for the preferred YMCA adult or household rate via payroll deduction.

However only associates on the OhioHealth medical plan or Opt-in to Wellness are eligible for the Fitness Rewards Program quarterly reimbursement.

Your E-mail Address *

Birthdate *

Month Day Year

Phone Number *

Emergency Contact Name

First Name Last Name

Emergency Contact Phone Number

Area Code Phone Number

Thank you for your request to change your membership to the OhioHealth Fitness Rewards membership. All changes must be submitted 14 days prior to your next monthly membership draft payment. Any changes made within 2 weeks of your next monthly payment will be made the following month.

The OhioHealth Fitness Membership Rewards Program was established with the goal of achieving healthier associates and can earn you a payback of up to 100% of your eligible individual membership fees. The program is a subsidy program that is based on attendance.

YMCA You Would Most Frequently Visit *

Need help choosing your closest Y? Check out this map of participating locations.

Do you currently have an active membership at another OhioHealth Fitness Center that you intend to maintain? *

Yes No

If yes, which facility would you prefer the visit tracking be based for the Fitness Incentive calculation?

OhioHealth YMCA

Member Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please note: Current YMCA members are not charged the enrollment fee. Only new members are charged the $69 enrollment fee.

Choose Membership Option: *

Individual - $18 per pay + no enrollment fee for current Y members (tax included) Household - $32 per pay + no enrollment fee for current Y members (tax included)

Type of Household Membership

Two adult + kids - Includes two adults and their children through the age of 24, sharing the same residence. One Adult + Kids - Includes one adult and their children through the age of 24, sharing the same residence. Two Adults - Includes two adults, sharing same residence.

Is the 2nd adult on membership also an OhioHealth associate who is enrolled in the OhioHealthy Medical Plan or the Opt-In-To Wellness plan

OhioHealth Clock Number for Second Adult

Which OhioHealth clock ID carries the medical plan?

Signature *

Clear

Branch Info

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Branch Staff

Branchphone