Child Safety Seat Appointment Request

2. Parent Name*

4. Phone Number*

5. Email

7. Number of Children in Child Restraints*

   1. 1
   2. 2
   3. 3
   4. 4
   5. 5

8. Number of Seats/Bases needing to be installed*

   1. 1
   2. 2
   3. 3
   4. 4
   5. 5

9. Number of Vehicles the Seats are being installed in*

   1. 1
   2. 2

11. Ages and Weights of Children in Child Restraints*

12. Preferred Date*
    Preferred Date

    Please provide the date you would prefer and an officer will contact you to confirm a time. Appointments are scheduled Monday through Friday during business hours.

14. If you have any questions, please call 972-721-2544.

Leave This Blank:


16. 1. Receive an email copy of this form.
17. Email address

    This field is not part of the form submission.

18. Submit

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