Car Seat Checkup Event
Please fill out the details below about your one-time car seat checkup event.
What is a Car Seat Checkup Event?
A car seat checkup event is typically a one-time event or a temporary, scheduled event. These events are often held periodically and are not permanent fixtures—meaning they occur on specific dates and times rather than being available on an ongoing basis.
Contact Information
Your Name (name of the person filling out the form)
*
First Name
Last Name
Organization Name
*
Role/Title
*
Phone Number
*
Please enter a valid phone number.
Email Address
*
example@example.com
Event Information
Car Seat Checkup Event Name (if applicable)
Name of the car seat checkup event.
Name of Lead Certified Child Passenger Safety Technician (CPST) at this event
*
First Name
Last Name
Organization Name
*
The name of the organization you’d like to have listed as the host for this one-time event.
Date
*
-
Month
-
Day
Year
Provide the date of the car seat checkup event.
Time
*
Start Time
AM
PM
AM/PM Option
Until
until
End Time
AM
PM
AM/PM Option
Total 0.0
Is this a reoccurring event?
*
Yes
No
Location of Car Seat Checkup Event:
*
Full address of the car seat checkup event location.
County of Car Seat Checkup Event
*
Please Select
Aitkin
Anoka
Becker
Beltrami
Benton
Big Stone
Blue Earth
Brown
Carlton
Carver
Cass
Chippewa
Chisago
Clay
Clearwater
Cook
Cottonwood
Crow Wing
Dakota
Dodge
Douglas
Faribault
Fillmore
Freeborn
Goodhue
Grant
Hennepin
Houston
Hubbard
Isanti
Itasca
Jackson
Kanabec
Kandiyohi
Kittson
Koochiching
Lac qui Parle
Lake of the Woods
Lake
Le Sueur
Lincoln
Lyon
Mahnomen
Marshall
Martin
McLeod
Meeker
Mille Lacs
Morrison
Mower
Murray
Nicollet
Nobles
Norman
Olmsted
Otter Tail
Pennington
Pine
Pipestone
Polk
Pope
Ramsey
Red Lake
Redwood
Renville
Rice
Rock
Roseau
Saint Louis
Scott
Sherburne
Sibley
Stearns
Steele
Stevens
Swift
Todd
Traverse
Wabasha
Wadena
Waseca
Washington
Watonwan
Wilkin
Winona
Wright
Yellow Medicine
Is an appointment required?
*
Yes
No
Do you allow walk-ins or drop-ins during the car seat checkup event operating hours?
*
Yes
No
How do people make an appointment? Choose one or more of the options available for scheduling an appointment.
*
Phone
Email
Website
No Appointment Required
Phone Number
Phone number people should call to make an appointment.
Email Address
Email address for appointment scheduling inquiries.
Website for Appointment Scheduling
URL of the website where appointments can be made.
Additional Information
Do you have restrictions for who is eligible to get their car seat checked?
*
Yes
No
Eligibility Restrictions for Car Seat Checks:
If there are any eligibility restrictions for who can attend the event, please provide the details.
Do you charge a fee for attending this car seat event?
*
Yes
No
If yes, what is the fee?
Provide the fee amount and any relevant details about what the fee covers.
Do you have a website with more information?
*
Please Select
Yes
No
Website URL:
URL of the website where appointments can be made.
Additional Information:
Any other important details, special instructions, or considerations for those attending the car seat check event.
Submit
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