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 overweight. The parents of these children will also be expected to attend nutrition classes along with their child, and be committed to the program for a period of 12 weeks, 3 days per week. You will receive a letter in the mail letting you know if your child(ren) qualify.

My Summer Success is now taking application for a FREE two week summer program for kids ages 8 to 12 year of age, as well as teens ages 13 to 17 years of age. There is NO BMI requirement.

Kids:

July 8^th – July 18^th from 8:00am-10:30am

Questions? Call us at (870) 936-7960 or email erica.huffstetler@bmhcc.org

Program 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:*
List current activities/sports:*
Family history (heart disease, diabetes, etc.):*
Mother's Name*
Age*
Height*
Weight*
Father's Name*
Age*
Height*
Weight*
Briefly describe why you wish to enroll your child in the Center for Healthy Children:*
My Summer Success Dates*
- June 10th-20th 1:00-3:30pm
- July 8th-18th 8:00-10:30am
- Teens Only: June 10th-20th MW 10am & TTR 1pm
You may only chose ONE date for summer camp.

Center for Healthy Children Application

Kids:

July 8th – July 18th from 8:00am-10:30am

Program Application

July 8^th – July 18^th from 8:00am-10:30am