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Nieto Consumer Panel Information Sheet Flowery Branch, Ga 30542   Fill in the information below and then click the submit button.  Parent/Guardian First/Last Name:       Date:     Street Address:     City:   State:  Zip:   Phone:     Alt.Phone:     Email:       Brand of Wipes Used Most Often:   Select One:   Huggies    Pampers    Whatever is on Sale    Store Brand    Other                        If Store Brand:      If Other:      Child #1 First Name:     Gender:   Boy    Girl    Birthday:     Weight(lbs):     Diaper Brand Used Most Often:   Select One:   Huggies    Luvs    Pampers    Whatever is on Sale    Store Brand    Other                        If Store Brand:      If Other:    Diaper Size:   Select One:   NB      1      2      3      4      5      6      Does Your Child Wear Training Pants?        Yes    No    TP Size:       Child #2 First Name:     Gender:   Boy    Girl    Birthday:     Weight(lbs):     Diaper Brand Used Most Often:   Select One:   Huggies    Luvs    Pampers    Whatever is on Sale    Store Brand    Other                        If Store Brand:      If Other:    Diaper Size:   Select One:   NB      1      2      3      4      5      6      Does Your Child Wear Training Pants?        Yes    No    TP Size:       Would you be interested in testing feminine care products?        Yes    No    If Yes, what do you use most often?        Pads    Tampons    Both    Tampon Type:        Cardboard    Plastic    Whatever is on Sale    Absorbancy:        Regular    Super      How did you learn about Nieto Research, Inc.  And our consumer product surveys?       (Name, Phone Number or Internet Website name)    Yes   I Accept the Terms of the Confidentiality Agreement Please check that your email address is correct. Our initial contact for Every study is via an email from Nieto Research, Inc.