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(The following information requested is optional, though your participation is highly encouraged.)
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| Name: |
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| Age: |
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| I am a/an: |
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| Your diapers |
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| Are you pantsless at home while in diapers? |
Always
Usually
Sometimes
Rarely
Never
I do not wear diapers
I was often in diapers and pantsless as a boy (ages 12 and under)
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| How do you use your diapers? |
Pee
Poop
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| How many older sisters do you have (boys only)? |
None
One
Two
Three
More than three
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| How many younger sisters do you have? (boys only) |
None
One
Two
Three
More than three
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| If you are a girl or adult female, indicate what your relationship is to the diaper boy who read this story:
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| Who else in your family has read this story? |
Mother
Father
Older Brother
Younger Brother
Older Sister
Younger Sister
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| Your comments: |
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| Parents' comments: |
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| Brothers' comments: |
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| Sisters' comments: |
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