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. Childhood obesity is defined as 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

New CFHC Application

What course are you registering for?*
Child's Name*
Age*
Birth Date*
Date Format: MM slash DD slash YYYY
Height (in)*
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:*
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