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 . A staff member will contact you within 72 business hours (this does not include weekends). click here Have you been affected by COVID-19?
Preferred Method of Contact
What other agencies are you accessing?
What are you requesting? (new car seat or checking current car seat or booster seat). Why is this needed? (e.g. loss of income, confirming car seat is installed correctly, etc.)
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):
By requesting items, I certify that I am using these products for personal use only and not for resale. We reserve the right to refuse requests for any reason without explanation. We cannot guarantee product availability and products. We reserve the right, without liability or prior notice, to revise, discontinue, or cease to make available any or all products or to cancel any request. Submit Please Note: This information is strictly confidential and any personal information will not be shared. Thanks for submitting! We have received your request.