Car Seat Clinic|Check Request
Please enter the following information and we will contact you as soon as a Car Seat Clinic is scheduled.
Do you currently have a car seat for each child? *
Is this request as a result of a car collision - is an accident report available? *
Parent Name [First and Last] *
Your answer
Name of person submitting this request - first name, last name, and agency
Your answer
How many children are in need of a car seat check? *
What are the ages of the child/ren? Please enter approx. weight, if known. *
Your answer
How do you want us to contact you? *
Phone Number/Text Number
Your answer
Email Address
Your answer
Comments - Questions or you may call - 231.592.9605 ext. 2040 and ask for Jesi
Your answer
THANK YOU! You will be notified when the next Car Seat Clinic is available.
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