Child safety seat inspections are provided free to Hoffman Estates residents.  If you have a child seat installed in your vehicle that you would like inspected for safety by a Certified Child Passenger Safety Technician, please fill out the form below.  A technician will walk you through proper installation and assist if needed.  The goal of the child safety seat inspection is to ensure care takers are confident in installing their child safety seat(s). 

1

Vehicle Owner Information:

 *

Name	Address
Phone Numberext.	Email Address

2

Relationship to Child:

Relationship to Child:

Parent/Guardian

Other If other, type text here.

3

Expectant Mother?

Expectant Mother?

No

Yes / Due Date If other, type text here.

4

Child Information:

 *

Child Information:

Child Age

Child Weight (lbs)

Child Height

5

Vehicle Information:

 *

Vehicle Information:

Vehicle Make

Year

Vehicle Model

6

Car Seat Information

 *

Car Seat Information

Name of Car Seat	Make of Car Seat
Model Number	Date of Manufacture

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

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