Car Seat and Car Seat Check Request Form
***Next Car Seat Event Saturday, June 1, 2024 from 10am - 2pm at Vern Burton Community Center in Port Angeles*** 

Car Seat Checks at First Step Family Support Center
For families in Clallam and Jefferson County, we provide free child car seat checkups with a Certified Passenger Safety Technician. Thank you for your interest in scheduling a car seat check.
Please fill out a checkup form below to request a child car seat check up and/or a new car seat. We will use this information to contact you for an appointment and provide instructions on how to prepare for your child car seat checkup. 
In order to complete this form, you will need access to your car seat. If requesting a car seat check for more than one child or vehicle, please complete additional forms.

Car Seat Check events are scheduled 2-3 times per month. Please be aware that you may have to wait several weeks for the next availability. We can only accommodate emergency car seat check requests as our Car Seat Technicians' schedules allow.
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Contact Information
Contact will be primarily through phone calls/text messages. Please note in the comment section if you need to communicate in another way.
Email
Full Name
 *
Phone Number *
Zip Code *
Car Seat Appointments 
Car Seat appointments are provided primarily at our Port Angeles office (323 E 6th Street). The vehicle and the child (if born) must be present for the appointment. Car Seat Checks last about 45 minutes, with about 15 minutes extra per child. 
Explain your car seat needs. What is your baby using now? What questions do you have about your car seat or installation? *
Car seat supplies are limited and are meant for families that cannot otherwise afford them. A car seat check is required for free car seat requests and a $30 donation for new seats will be requested. 

Our program provides convertible car seats that are designed to fit a child from birth to 5 years old (example below). Please note that we do not provide infant carry car seats. 
How did you hear about our car seat program? (If you were referred by a First Step employee, please provide their name here:) *
Have you received a car seat from our program before? *
Child Information
If child is not born yet, write unborn in your answers.
Child First Name *
Child Month & Year of Birth (mm/yyyy) OR Expected Due Date *
Child Estimated Weight (if born) *
Child Estimated Height (if born) *
Optional Information
The following information is optional, but will help our Car Seat Technicians better prepare for your appointment.
Does your child have any special transportation needs?
Other children, such as siblings, who regularly ride in the vehicle (age/weight):
Vehicle Information  
Find the following information on registration documents, the vehicle owner’s manual, and/or on the sticker inside the driver-side door’s doorframe. Example:
Make (i.e. Ford, Toyota, Subaru, etc):
Model (i.e. Escape, Sienna, Outback, etc):
Model Year:
Model Style (i.e. van, SUV, sedan, convertible):
Do you have a hard copy of the vehicle owner's manual?:
Clear selection
Car Seat Information 
 
Find the following information on a sticker on the car seat and/or its base. It is also located on the postcard that should be mailed in to register for recalls. 
Car Seat Brand: (ie: Baby Jogger, Baby Trend, Britax, Chicco, Clek, Combi, Cosco, Cybex, Diono, Evenflo, Graco, Harmony, Kids Embrace, Nuna, Peg Perego, Uppababy, Urbini, other)
Car seat Model Name:
Car Seat Model Number (example above):
Car Seat Manufacture Date:
Do you have a copy of the car seat owner's manual?:
Clear selection
Questions/Comments
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