Apply for a Wizzybug

Step 1 of 4

Representation

If you are filing this form out on behalf of someone else, please tick here.

Please enter your name(Required)

Please enter your email

What is your relationship to the applicant?

Please enter your address

House number and street name Address line 2 Town / City County Postcode

Please enter your contact number

Parent/Guardian details

First name(Required)

Last name(Required)

Email address(Required)

I give permission for my email address to be added to Designability's mailing list so I may be contacted with Wizzybug news and events.(Required)

Yes

Mobile Phone Number

Please enter your full mobile phone number (ie, 07753753731)

Additional Phone Number

Please enter your home phone number with your UK area code

Parent/Guardian address(Required)

House number and street name Address line 2 Town / City County Postcode

How did you hear about the Wizzybug loan scheme?

Please give website address

Which social media channel?

Please give therapist's name and profession

Please give the name of the exhibition

Please give the name of the organisation

Please give the name of the publication

Please describe

About your child

First name(Required)

Last name(Required)

Sex(Required)

Date of birth(Required)

Does your child have a named medical condition or diagnosis?

Yes

Please describe how your child's disability impacts them and what investigations they are currently having.

Add relevant information regarding: vision, hearing, non-oral feeding, seizures, choking, aspiration

Please write your child's diagnosis here, if they have more than one diagnosis that you think we should know about, please add it using a comma to separate out each diagnosis.

Child's weight in Kilograms(Required)

Child's height in Centimetres(Required)

Please enter a number less than or equal to 110.

Please note that Children above 110cm are likely to be too tall for Wizzybug.

If your child is over 18kg, please be aware that your application may be declined as Wizzybug may be too small. Our maximum weight limit is 20kg and any applications over this weight will be declined.

Please describe your child's sitting ability

e.g. can sit independently, can sit with some support, needs full support to sit

Wizzybug has a flat headrest and therefore children must be able to hold their head up independently to safely use it.

If your child has difficulty with this, please do not submit your application until you have discussed the suitability of wizzybug with your local therapist or contacted us directly.

Please refer to our User requirements guidlines for further information.

Can your child independently hold their head up?

Yes

Wizzybug has a flat headrest and therefore children must be able to hold their head up independently to safely use it.

If your child has difficulty with this, please do not submit your application until you have discussed the suitability of wizzybug with your local therapist or contacted us directly.

Please refer to our User requirements guidelines for further information.

Please describe how your child currently moves around

e.g. walking with support, using a walker, crawling, rolling, carried etc...

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Parent/Guardian details

About your child

Your Wizzybug Appointment

General Contact and Privacy Consent

Inclusion section

About your child

About your family - Disability

About your family - Financial circumstances