Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Outreach Car Seat Inspections

  1. Parent Information
  2. Child Information
  3. Parent Release of Liability

    I understand that the sole purpose of this program is to reduce the incident of improper installation and use of child safety seats; this inspection is provided free of charge in the interest of public safety; this program cannot fully evaluate the quality, safety, condition of the child safety seat, or any component of my vehicle including the seats, safety belts, and airbag systems; and that this program cannot guarantee my child's safety in a crash. I understand that to have full protective benefit of the child safety seat the infant and or child must at all times be properly secured in the child safety seat and the child safety seat must at all times be properly secured to the vehicle in accordance with the vehicle and child safety seat manufacturer's instructions. I hereby release any program participants from any present or future liability for any injuries including death or dangers that may result from a vehicle collision or otherwise.

    I understand that on occasion a great deal of force must be used to properly secure the child safety seat into the vehicle. I release all agencies and personnel involved form liability and responsibility for any and all damage(s) caused to my vehicle and/or contents therein while installing the child safety seats.


  4. By typing my name here I agree and consent to the Parent Release of Liability statement above.

  5. Seat information
  6. How the seat Arrived
  7. Participant was notified of any issues in this section
  8. Checking for Errors

    Indicate errors found 

  9. Child seat in correct location in vehicle
  10. Carrier handle in correct travel position
  11. Seat is facing correct direction?
  12. Seat installed at correct angle?
  13. Seat tightly installed?
  14. Safety belt in locking mode?
  15. Locking clip used correctly?
  16. Safety belt routed correctly?
  17. Tether used correctly?
  18. LATCH used correctly?
  19. Harness in correct slots?
  20. Harness snug/ education provided?
  21. Harness retainer clip at armpit level/ education given
  22. Harness Free of tear or twists/ education given
  23. Additional Education Provided
  24. Leave This Blank:

  25. This field is not part of the form submission.