New Car Seat & Car Seat Check Requests

Please fill out the form below if you are in need of a new car seat OR if you need one of our Child Passenger Seat Technicians to check your current car seat or booster seat. You will receive a confirmation email after submitting and a staff member will reach out to you within 72 business hours.

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WE WANT TO HEAR FROM YOU!

Our islands are beautiful; however, resources can be scarce at times. By taking this 5 MINUTE survey, you can tell us what resources your family needs and help us tailor our services to best meet your needs. The survey is completely anonymous. Thank you for sharing your voice!

Click here to take this short survey!

Thank You!
New Car Seat & Car Seat Check Request Form

Please complete this form only if you are requesting a car new seat or need a check or your current car seat or booster seat. If you need diapers, transportation, or any other request, please click here. A staff member will contact you within 72 business hours (this does not include weekends).

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Single?
Healthy Babies Client?
Healthy Start Client?
Preferred Method of Contact
What other agencies are you accessing?
Do you own a vehicle?
Are you using public transportation?
Can you safely travel to us to receive the car seat or car seat check?
Is the child already using a car seat?
Please select the following (you may choose more than one):

Please Note: This information is strictly confidential and any personal information will not be shared.

Thanks for submitting! We have received your request.