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 [email protected] 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

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 (we will email you personally to find out what size would be required)
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

2 Vests will be sent to you in the post. We have very limited colours in stock, however, where we can, we will do our upmost to select vests in your preferred colour. Please state below any particular colour choices you would like.

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

[email protected]

03301335699

Joseph's Smile

Registered Charity: 1199979

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