| Parent / Guardian Information |
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| Full Name: | * |
| Address: | |
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| Town/City: | |
| Postal Code: | |
| Country: | |
| Email: | * |
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| Primary Residence: | |
| Child Information (youngest child) |
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| Child's Birthday: | |
| Child's Gender: | |
| Number of Children in Household: | |
| Product Information |
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| Product Name: | * |
| Favourite Feature of this product: | |
| How can we improve this product: | |
| What other types of product would you like to see us make: |
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| Why did you buy this product: | |
| Were the insutuctions easy to follow: | |
| Place of Purchase: | |
| How you heard about this product: | |
| Your First Little Tikes Toy: | |
| How many Little Tikes products you own: | |
| Which of the following do you own: | |
| Product Research |
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Tell us what product this is by filling in the last six digits of the upc/barcode found on the bottom of the box: | |