CHILD CAR SEAT CLASS REGISTRATION

Advanced registration is required. Class dates, time and location are subject to change. After you submit a registration request, you will receive an email from us within one week to confirm class date and attendance.

1

Full Name

 *

Full Name

2

Email Address

 *

Email Address

3

Phone Number

 *

Phone Number ext.

4

City

City

5

Zip Code

 *

Zip Code

6

I am a:

 *

I am a:

Parent/Caregiver

Child care provider

Contracted transporter

Other If other, type text here.

7

Class time and day:

Class time and day:

1 p.m. first Thursday of the month

6:30 p.m. third Wednesday of the month

8

How did you hear about this class? What makes you interested in our child car seat class?

How did you hear about this class? What makes you interested in our child car seat class?

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

To prevent spam we utilize a verification code system. Please enter the code as it is shown in the box below:

 

Code:

Page 1 / 1