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2. CAR SEAT INSPECTION REQUEST FORM

4. One study showed that up to 46% of observed car seats and booster seats were used or installed incorrectly. With one person in the nation injured every 13 seconds during a motor vehicle crash, ensuring that you are using best practice safety measures for your loved one by having one of our certified car seat safety technicians check your car seat can help to minimize injuries or devastating loss of life due to preventable mistakes.

   MAKE AN APPOINTMENT TODAY! (You do not have to be a resident of KG county to receive this service.)

   (We do accept walk-ins, however it is not guaranteed that a technician will be available at that time. Additionally, inspections are subject to interruptions if emergency incidents require the technician to respond.) 

6. Completing as much information on this form will assist the technician and in most cases will decrease the administrative time spent at the inspection.

8. Name
9. Email Address
10. Phone Number
12. Address
14. City
15. State
16. Zip Code
18. Infant/Child/Booster Seat to be inspected:

    Inspections can still be performed regardless of your selections.

20. I have multiple car seats to be inspected.

    1. Yes

    1. No
22. The car seat(s) being inspected is:

    1. Brand new, never used
    2. New to me, used
24. The car seat(s) being inspected has never been involved in an accident.

    1. Yes

    1. No
26. I have the car/booster seat's manufacturer's manual.

    1. Yes

    1. No
28. I have registered the car/booster seat with the manufacturer.

    1. Yes

    1. No
30. The infant/child will be present at the car seat check.

    1. Yes

    1. No
32. Child/Infant AGE, HEIGHT AND WEIGHT
34. Car Seat MAKE/MODEL/Year of Purchase (if known).

    Please list information for every car seat to be inspected.

36. Vehicle to be used for the Inspection

    Do you have the Vehicle's manufacturer manual?

    1. Yes

    1. No
38. Vehicle's YEAR/MAKE/MODEL
40. Requested Date/Time of Availability

    Please provide multiple general or specific dates/times that you will be available to come to our station to have the inspection performed.

42. Location of Inspection

    Select your location of preference.

    1. 8122 Kings Highway (Co 1)

    1. 16147 Dahlgren Rd (Co 2)

    1. 6060 Riverview Dr (Co 3)

44. Caregivers should expect the child/infant/booster seat inspection to take approximately one hour.

    The inspection will consist of observation by the caregiver(s) of the proper installation of the seat by the technician, then the caregiver(s) will properly install the seat themselves into their vehicle prior to departure to complete the inspection.

    *Caregivers should bring all available manufacturer manuals with them to the inspection.*

    Any further questions can be directed to Lt. McGee at 540-775-8904.

    You will be contacted upon receipt of your submitted form to confirm the appointment.

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field