JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
8/31/2021 Class registration-McHenry County 10am
Attend a 1 hr. virtual Child Passenger Safety class to be eligible to receive a car seat or booster seat for your child.
***One seat per child, must qualify***
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name (Parent)
*
Your answer
Parent email
*
Your answer
Household Size
*
2
3
4
5
6+
Race
*
Asian
Black or African American
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White
Hispanic origin
Comfort level installing a car seat
*
Not comfortable at all
1
2
3
Very comfortable
Child #1 birthday
*
MM
/
DD
/
YYYY
Child #1 current weight
*
Your answer
Child #2 birthday
MM
/
DD
/
YYYY
Child #2 Current weight
Your answer
Child #3 birthday
MM
/
DD
/
YYYY
Child #3 current weight
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
