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2. Please complete this form to request a car seat check from Cosumnes Fire Department's Car Seat Technician. 

   The appointment is an interactive experience to help you learn how to install a car seat safely. Please allow for at least 45 minutes and be prepared to complete a form called the "Child Passenger Safety Checklist." 

4. First Name*
5. Last Name*
7. Email Address*
8. Phone Number*
10. Address*
12. City*
13. State
14. Zip Code*
16. Car Year/Make & Model*
17. Car Seat Manufacturer Name*

19. We provide car seat checks Tuesday-Thursday afternoons. Please select a time frame that would work best for your schedule, and plan for at least a 45-minute appointment. 

21. Time Frame *

    Check all that apply. 

    1. Tuesday afternoon, 2:00 pm
    2. Tuesday afternoon, 3:00 pm
    3. Tuesday afternoon, 4:00 pm
    4. Wednesday afternoon, 2:00 pm
    5. Wednesday afternoon, 3:00 pm
    6. Thursday afternoon, 2:00 pm
    7. Thursday afternoon, 3:00 pm
    8. Thursday afternoon, 4:00 pm
25. Disclaimers

    1. Please be aware that appointments are based on the availability of the Car Seat Technician, and we will strive to accommodate your preferred appointment date and time accordingly.

    2. Once your appointment is scheduled with our Car Seat Technician, please bring the physical car seat, Car Owner's Manual, and Car Seat Manual. 

    3. If the child passenger is not present during the actual appointment, please be prepared to answer questions about their age, weight, and height. 

    4. If you book an appointment and are outside of our jurisdiction, we may refer you to another Car Seat technician. At this time, we do not provide free car seats. 

27. Acknowledgement*

    1. I acknowledge these disclaimers.

     

Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

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