HARD COPY Materials Order Request
Please fill out the required information, select the quantities of materials that you would like sent to you and electronically agree to the below terms. All materials will be sent via hard copy in the mail to the address you specify on this form.

I agree to abide by the following requirements set forth by Maryland Kids In Safety Seats:
1. Safe Ride News Fact Sheets must be duplicated as is, with no alterations or modifications permitted.
2. Safe Ride News Fact Sheets must be distributed free of charge.
3. Safe Ride News Fact Sheets may NOT be uploaded to a website or made available as a digital copy.
4. Safe Ride News Fact Sheets should be updated once per year by contacting KISS for the most recent versions.
5. Community based organizations/agencies must report the estimated quantities of SRN Fact Sheets to be printed (for the calendar year in which they are requested) to MD KISS via fax or e-mail, using this form.

Thank you!
Email *
Your name (First and Last) *
Agency Name *
Phone number *
Street Address *
City *
State *
Zipcode *
E-mail *
English Materials
10
25
50
Every Child Deserves a Safe Ride Brochure
Maryland's CPS Law/5 Step Test (2-sided Flier)
SRN: Check Your Child’s Car Seat!
SRN: Selecting the Right Car Seat
SRN: Are You Pregnant? Buckling Up For Two
How Long Rear-Facing (max qty. 10 printed)
SRN: This Is the Way Baby Rides
SRN: Car Safety For Growing Babies/Toddlers
SRN: Meeting the Car Seat Challenge (Toddlers/Preschoolers)
SRN: Boosters for Big Kids
SRN: Buckling Up, Keeping Youth Safe
SRN: Grandparents Guide to Car Seats
SRN: Car Seats and Pick-up Trucks (max qty. 10 printed)
SRN: What to do About Recalls (max qty. 10 printed)
SRN: Parked Cars- Dangerous for Kids (max qty. 10 printed)
SRN: Safer Airplane Travel (max qty. 10 printed)
Clear selection
Spanish Materials
10
25
50
SRN: Check Your Child’s Car Seat!
SRN: Selecting the Right Car Seat
SRN: Are You Pregnant? Buckling Up For Two
How Long Rear-Facing (max qty. 10 printed)
SRN: This Is the Way Baby Rides
SRN: Car Safety For Growing Babies/Toddlers
SRN: Meeting the Car Seat Challenge (Toddlers/Preschoolers)
SRN: Boosters for Big Kids
SRN: Buckling Up, Keeping Youth Safe
SRN: Grandparents Guide to Car Seats
SRN: Car Seats and Pick-up Trucks (max qty. 10 printed)
SRN: What to do About Recalls (max qty. 10 printed)
SRN: Parked Cars- Dangerous for Kids (max qty. 10 printed)
SRN: Safer Airplane Travel (max qty. 10 printed)
Clear selection
PLEASE SIGN/TYPE FIRST AND LAST NAME AND DATE BELOW: *
Submit
Never submit passwords through Google Forms.
This form was created inside of State of Maryland. Report Abuse