Coon Rapids Appointment Request
Request an appointment for a Safe Kids Coon Rapids car seat clinic, your appointment is NOT scheduled until confirmed by a Safe Kids Coon Rapids Technician. If you are seeking a free seat and you have U-Care, due to HIPAA rules, we will need to collect additional information over the phone to confirm your eligibility prior to booking your appointment. Please call us at 763-767-6481 prior to completing this form.
Parent/Caregiver Name
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First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
What Anoka County city do you reside in?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Are you seeking a free seat?
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No
Yes, My child (or I) am on UCARE.
Yes, My child (or I) are NOT on UCARE.
Non-U-Care provided free seats are not always available, and subject to a need-based screening criteria, please fill out the form and we will be in touch to confirm the availability prior to appointment booking. If you have U-Care, we will need to collect additional information over the phone to confirm your eligibility prior to booking your appointment. Please call us at 763-767-6481
Make, model, year and color of your vehicle(s)
*
This helps us spot your car when you pull into the parking lot!
Age(s) of child(ren)
*
Number of seats to install
*
1
2
3
4+
Make and model of car seats:
*
E. G. Graco 4Ever,Cosco Scenera, Chicco Keyfit etc.
Appointment Selection
(select an appointment for each vehicle)
January 11th, 2023 Clinic | Coon Rapids Police Department
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March 22nd, 2023 Clinic | Coon Rapids Police Department
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February 22nd, 2023 Clinic | Coon Rapids Police Department
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May 11th, 2023 Clinic | Coon Rapids Police Department
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June 8th, 2023 Clinic | Coon Rapids Police Department
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July 26th, 2023 Clinic | Coon Rapids Police Department
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August 16th 2023 Clinic | Coon Rapids Police Department
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September 20th 2023 Clinic | Coon Rapids Police Department
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October11th 2023 Clinic | Coon Rapids Police Department
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November 8th 2023 Clinic | Coon Rapids Police Department
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December 14th 2023 Clinic | Coon Rapids Police Department
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January 10th 2024 Clinic | Coon Rapids Police Department
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February 26th 2024 Clinic | Coon Rapids Police Department
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March 21st 2024 Clinic | Coon Rapids Police Department
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April 22nd 2024 Clinic | Coon Rapids Police Department
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June 5th 2024 Clinic | Coon Rapids Police Department
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Anything else we should know?
Submit
Should be Empty: