Clone of 2025 Holiday Cheer Program

Clone of 2025 Holiday Cheer Program

Car Seat Safety Class

Please limit to one household per submittal.
Please review and confirm you understand all Car Seat Safety Class Program guidelines
- Must be a Moreno Valley resident (proof of residency required)
- One submittal per household
- Only the people on the application are allowed to participate
- Provide a valid ID at the time of the event
- Limit 1 car seat per residence (2 for twin babies)
*Acceptance into the program is at the discretion of Moreno Valley Sheriff’s Station. This form serves only as an intake; you will be asked to complete the full application once your submission has been reviewed and approved to move forward.

*The applicant acknowledges that they own a vehicle that can accommodate a rear-facing car seat and that the rear seat belts are in safe, working condition in accordance with the California Vehicle Code (CVC)
Signature*

Parent/Guardian & Child Information
Parent/Guardian*

First NameMiddle NameLast Name
Child's Information*
Parent/Guardian Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Vehicle Information*

Vehicle year, make & model

License Plate No.

City

Postal /Zip Code

I certify that the information provided above is true and current as of the date signed and verification will be provided, if necessary.*
Date*

MonthDayYear
Date
Should be Empty: