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Columbus Public Health Car Seat Program

Car Seat Program Infoline 614-645-7748

Car Seat Program Infoline 614-645-7748

Hello! DECEMBER appointments are fully booked. IF YOUR DUE DATE IS WITHIN 3 WEEKS FROM NOW, WE WILL NOT BE ABLE TO ASSIST YOU.
If you need further assistance, please email us in any language at carseats@columbus.gov

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Car Seat Appointment

June 27 @ 9:30 AM - 12:30 PM

« Private Appointment
Private Appointment »

2024 - Registrant Information

Appt. Date *

Appt. Time

Appointment *

I am scheduling this appointment for... *

Myself

Someone Else

Your Name (First and Last) *

Agency/Program/Relation *

Email *

Registrant Information

First Name *

Last Name *

Relation to Child * Relation to Child

Preferred Language * Preferred Language

Do you need an interpreter? *

Yes

*7 day notice required for interpreter

Receiving WIC *

Receiving Medicaid *

Medicaid Provider *

How did you hear about our program? * How did you hear about our program?

Please specify

Are you pregnant or expecting? *

Yes

(If "Yes", don't forget to include this child below)

Expected Delivery Date *

List All Children Under the Age of 8 WITHOUT a Car Seat or Booster Seat

By Ohio law, all children under the age of 8 years old must ride in a car seat or booster seat

Child

Has this child been born yet? *

Yes

Child's First Name *

Date of Birth *

Child's Weight *

Add another child Remove this child

Household Information

Zip Code *

Mobile/Cell Number *

10-digit mobile number for text reminders

*email provided will be used for Car Seat Program communications only

Comments / Special Requests

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Follow-up

Ethnicity

Attendance

Payment

Amount Paid

Payment Type

Cash

Check

Check Number *

Consents

Consent Statements *

I understand I have to pay a fee for my car seat(s) and/or booster seat(s) at the time of my appointment.

Appointment Consent *

I understand the appointment will take 20 – 30 minutes to cover the full education of the car seat and its installation.

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Details

Date:: June 27
Time:: 9:30 AM - 12:30 PM
Event Category:: General Appointment

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Private Appointment »