The Wiggly Vest

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The Wiggly Vest
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Cart/£0.00

0

Donate

Home
About
- Contact Us
Get Involved
Our Supporters
- Patrons
- Corporate sponsors
Grant Scheme
The Wiggly Vest
Shop

If you are a parent requesting a Wiggly Vest for your child, please complete the form below. If you are a practitioner who would like to rerquest Wiggly Vests for your patients, please email info@josephssmile.org with your request.

Parent name *

Email *

Please state the name of the hospital that your child attends for treatment and the name of your child's doctor. *

Child's name

Address for delivery *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Unfortunately, we are only able to deliver to UK regions.

Phone

Gender of the child *

Boy
Girl
Rather not say, please send me vests that are suitable for either a boy or girl.

Size of vest required *

Baby Vest - 0-3 months
Baby Vest - 3-6 months
Baby Vest - 6-9 months
Baby Vest - 9-12 months
Baby Vest - 12-18 months
Baby Vest - 18-24 months
1.5-2 Years
2-3 Years
3-4 Years
4-5 Years
5-6 Years
6-7 Years
7-8 Years
8-9 Years
9-10 Years
10-11 Years
11-12 Years
Other (we will email you personally to find out what size would be required)

Please state what side your child's Hickman Line (Wiggly) is placed *

Right Chest
Left Chest
Please can you make an entrance hole on both sides of the vest

If you have any other questions, please state them below.

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

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Registered Charity in England and Wales: 1199979

info@Josephssmile.org

03301335699

Joseph's Smile

Registered Charity: 1199979

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