Car Seat Clinic Registration

FREE CAR SEAT SAFETY APPOINTMENTS

Receive a Free Car Seat*

Please fill out your information below or call 765-449-5133 to register for a free clinic appointment.

Your child(ren) must be present for this car seat inspection. The only exception is if you are expecting a child.

*Some qualifications required to receive a free car seat. While supplies last.

(These qualifications revolve around lacking a car seat that is safe and adequate for your child. If your current seat fits your child,
is not expired/recalled and is deemed appropriate and safe for your child’s age, height and weight then a new seat will not be issued.)

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number*

Email*

Number of car seats being checked?*

What is your due date?*

Tell us more about why you are scheduling this car seat check appointment (check all that apply)*

I am pregnant and already have a car seat but want to ensure proper installation I am pregnant and do not have a car seat I am unsure if my child's current car seat is appropriate for their age, weight and height I just transitioned my child to a different car seat/moved them rear to forward facing and I want to ensure proper installation I have a car seat but am unsure of how to install it properly I do not have a car seat for my child

Other:

What is the Make, Model and Year of your vehicle? (example: Toyota Camry 2019)*