Center for Healthy Children Application

NEA Baptist Charitable Foundation Center for Healthy Children will provide (free of charge) nutrition education & exercise programs for children who are obese. Childhood obesity is defined as having a BMI above the 95th percentile for their age and gender.

Don’t know your child’s BMI? Calculate it here.

Questions? Call us at (870) 936-7124 or email raylee.wallace@bmhcc.org

Program Application

In order for a child to participate in the Center for Healthy Children they must have this application filled out and submitted by a parent or legal guardian. Acceptance or denial into the program will be given within five business days.

Child's Name*
Age*
Height (in)*
Weight*
School*
Applicant Name*
Relationship to Child*
Phone*
Email*
Family Physician*
Family history (heart disease, diabetes, etc.):*
List current health problems and/or allergies:*
List current activities/sports:*
Does your child use an inhaler?*
If yes, can you provide a spare to be held at the Center?
If no, the child will need his/hers everyday.
If accepted, will the child have reliable means of transportation as well as a parent or guardian available to participate in family classes?*
Please note that attendance will be kept and both child and parent are expected to attend all classes or risk removal from the program.