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]
Name of person submitting this request - first name, last name, and agency
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.
How do you want us to contact you?
Phone Number/Text Number
Comments - Questions or you may call - 231.592.9605 ext. 2040 and ask for Jesi
THANK YOU! You will be notified when the next Car Seat Clinic is available.
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