Center for Healthy Children Application

NEA Baptist Charitable Foundation Center for Healthy Children will provide (free of charge) nutrition education, diet and exercise programs for children who are obese. Obesity in children is defined by having a BMI above the 95th percentile for their age and gender. If you’re unaware of your child’s BMI you can calculate it here.

Questions? Call us at (870) 936-7960 or email Will.OliverIII@BMHCC.org

Program Application

CHC Summer Application

Child's Name*
Age*
Birth Date*
Date Format: MM slash DD slash YYYY
Height*
Weight*
School*
Grade*
T-shirt Size*
Applicant Name*
Relationship to Child*
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Family Physician*
List current health problems and/or allergies:*
What session of The Center for Healthy Children would you like to your child to attend?*
Each session has a cap of 16 children. If your requested session is full we will enter them in the session with open slots.
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.
Family history (heart disease, diabetes, etc.):*
Mother's Name*
Age*
Height*
Weight*
Email
Father's Name*
Age*
Height*
Weight*
Email