Suitability form - Stay Dry at Night

Is Your Child Suitable for Stay Dry at Night?

To find out if this program is suitable for your child, please answer the following questions.

All information is treated in the strictest of confidence and in accordance with our privacy policy.

Child's First Name

Child's Date of Birth (Please check this after entering)

Child's Gender

Male Female

Medical Conditions

Asperger's Syndrome Brain Trauma Epilepsy None of the above

Disabilities

Yes No

Disability Details

Your First Name

Your Last Name

Your Email