Car Seat Appointment Form-First 5 Yuba County
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  • Car Seat Check-Up Event

    May 22, 2026

  • Upcoming Check-Up Event

    May 22, 2026

    1:00-4:00 pm

    @ YES Charter

    9841 Texas Hill Road

    Oregon House, CA 95962

     

    ⚠️ IMPORTANT: What You Should Know Before This Event ⚠️

     🚗 Event Format: This is a drive-thru service where you'll arrive in your vehicle and have the opportunity to step out for hands-on installation practice with our technicians. We focus on car seat education and installation support. We are NOT a general free car seat giveaway program. New/replacement seats are distributed on a case-by-case basis while inventory allows.

    🔍 What to Expect: A certified Child Passenger Safety Technician will evaluate your car seat setup and guide you through proper installation techniques to support your child's safety.

    📋 Required Items:

    • Your vehicle with your current car seat (if you have one)
    • If you want your child fitted/replacement seat, you MUST bring the child
    • or if pregnant, please be in your 3rd trimester

    ⚠️ Please Note: Free car seats are not guaranteed at this event. Technicians may recommend or provide a new seat based on availability and safety needs identified during your check-up.


    Our technicians CAN:

    ✅ Provide education about car seat safety
    ✅ Help with proper installation techniques
    ✅ Check if your current seat fits your child and vehicle
    ✅ Show you how to use your car seat correctly


    Our technicans CANNOT: 

    ❌ Gurantee your vehicle or car seat's safety/condition 
    ❌ Guarantee your child's safety in a crash
    ❌ Provide warranties about any equipment or services

    Your responsibility: Always read and follow both your car seat AND vehicle manuals.

    🕒 Next Steps: After submitting this form, a technican will send you a text message confirmation within 3-5 business days. 

    📞 Questions? Call our office: 530-749-4877

     

  • Appointment*

  • Caregiver's Information

    .
  •  -
  • My preferred language is:*

  • Caregiver Date of Birth*
     - -
  • How did you hear about this program?*

  • Vehicle Information

    You will need to have a vehicle at this appointment so we can properly install the car seat. Please let us know what kind of vehicle you plan to bring to this appointment.

  • 1st Child's Information

    For expecting parents, use baby's name (if chosen) or "Baby" and your due date.
  • 1st Child's Date of Birth (or expected date)*
     - -
  • For Child 1:*

  • If you have any questions when filling out the form call our office at (530) 749-4877.

  • 2nd Child's Information

    For expecting parents, use baby's name (if chosen) or "Baby" and your due date.
  • 2nd Child's Date of Birth (or expected date)
     - -
  • For Child 2:

  • If you have any questions when filling out the form call our office at (530) 749-4877.

  • 3rd Child's Information

    For expecting parents, use baby's name (if chosen) or "Baby" and your due date.
  • 3rd Child's Date of Birth (or expected date)
     - -
  • For Child 2:

  • Do you have more than three (3) seats to be inspected? If yes, we will collect the additional information when we call to verify your appointment.

  • If you have any questions when filling out the form call our office at (530) 749-4877.

  • Sign the Waiver of Liability

  • WHEREAS, I have voluntarily sought individual education concerning child safety seat installation conducted by First 5 Yuba County and, WHEREAS, I have been informed and advised that  First 5 Yuba County makes no express, or implied warranties as to the safety or fitness of any child safety seat; and WHEREAS, I have been informed and advised that in order for my child to be fully protected, I must secure my child in the child safety seat properly at all times, and at all times secure the safety seat properly in my vehicle according to the safety seat manufacturer's instruction which have been provided to me and according to the vehicle manual. NOW THEREFORE, in consideration of being provided with a child safety seat, I hereby agree:

    1. That First 5 Yuba County its officers, agents, employees and volunteers, and each of them shall not be responsible or liable for any injury, damage, loss or expense, either to me or my property incurred by my use of the afore-mentioned child safety seat.

    2. I, my heirs, executors, administrators, and assigns hereby agree to defend and indemnify First 5 Yuba County, its officers, agents employees and volunteers, and each of them, against any and all manner of actions, causes of actions, suits, debts, claims, demands for damages or liability of expense of every kind and nature incurred or arising by reason of any actual or claimed negligent wrongful act or omission by me relating to the use of the afore-mentioned child safety seat.

    I hereby represent that I can read, write, and understand the language in which this document is written and that I have carefully read and understand the contents of this document and that I am of 18 years of age or older.

  • Signature (Parent/Gaurdian/Caregiver Name) I agree with the terms outlined by the waiver above. And that the information I have provided on this form is correct

     

     

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