Child Car Seat Safety Check Request Form

Receive a free Child Car Seat Safety Check from a certified Child Passenger Safety Technician at REACHUP. Appointments are required. All car seat checks will take place at:

REACHUP
2902 N Armenia Ave
Tampa, FL 33607

What to Bring:

Your vehicle
Your child’s car seat
Your vehicle owner’s manual
Your car seat manual

If you are requesting a car seat, you must also bring proof of Medicaid, SNAP (Food Stamps), or WIC benefits to your appointment.

Full Name*

First NameLast Name

Phone Number*

Email Address*

Are you currently enrolled in a REACHUP program?*

YesNo

Which REACHUP program(s) are you currently enrolled in?

What date and time work best for you?*

Color, Year, Make, and Model of your Vehicle*

Manufacturer and Model of Car Seat*

If you do not have a car seat, write N/A

Are you in need of a car seat? (You must show proof of Medicaid, SNAP (Food Stamps), or WIC benefits.)*

YesNo

If you are in need of a car seat, please provide your child’s age so we can select the appropriate seat.

Child Car Seat Safety Checks