Car Seat Inspection Request

Car Seat Inspection Request
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Car seat inspection appointments are held at the front parking lot for the Tomball Police Department:

Tomball Police Department
400 Fannin Street
Tomball, TX 77375

If you would prefer a different location, visit Safe Kids Greater Houston's scheduling site for other Houston-area locations: http://www.freeseatcheck.as.me/
Select an appointment from these available dates/times. If you are not able to attend during one of these times, please contact Angela at afagg@tomballtx.gov or 281-290-1303 to see if an alternative time or location can be arranged.*
Parent / Caregiver Name:*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address (to pre-fill your Inspection form)*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
How did you hear about this Inspection Station?

Drive-UpEMS WebsiteSocial MediaWord of MouthInternet SearchBrochure/FlyerClinic/HospitalReferred by another agencyOther
Do you have a car seat?*

Yes (new/good condition)Yes, but it may be expired and/or brokenNo, I am in need of a car seat

Car Seat Information:*

Vehicle Information:*

Rows	Make	Model	Year	Do You Have Manual?	Car Seat to be installed (from above)
Vehicle 1
Vehicle 2

Child Information: *

Any questions or concerns you want to address at your appointment and/or explanation of child's special needs, to help CPSTs prepare for your unique needs:
Should be Empty: