St. Petersburg Car Seat Registration

To register for a Car Seat Safety Check at All Children's Main Campus in St. Petersburg, please complete the form below.

Parking is available on the rooftop of the ACH Visitors Parking Garage located next to the OCC.

Class is held in the Family Resource Center in the Outpatient Care Center on the 2nd Floor. (From parking take the elevator to the 2nd Floor and cross the bridge between the garage and OCC. Family Resource Center is on the right past the Visitors Desk).

To ensure every child travels safely, our program offers car seats at a reduced cost for those that meet program criteria. Convertible seats are available for a donation of $20 and boosters for $10 (cash or money orders only). Prices may vary accommodating special circumstances such as high weight limit. Supplies are limited to 1 car seat per child and appointments are required.

Appointment Date * 
12/03/14, 09:30 AM @ Outpatient Care Center on 2nd Floor, St. Petersburg 
12/10/14, 09:30 AM @ Outpatient Care Center on 2nd Floor, St. Petersburg 
12/17/14, 09:30 AM @ Outpatient Care Center on 2nd Floor, St. Petersburg 
Caregiver First Name * 
Caregiver Last Name * 
City 
County 
Phone *  () - Ext.
Email Address 


Child 1: Age * 
Child 1: Weight * 
Child 1: Height * 
Child 1: Does this
child have any
special needs? * 
Child 1: Does this
child have a
car seat/booster seat? * 
Yes  No 



Child 2: Age 
Child 2: Weight 
Child 2: Height 
Child 2: Does this
child have any
special needs? 
Child 2: Does this
child have a
car seat/booster seat? 
Yes  No 



Child 3: Age 
Child 3: Weight 
Child 3: Height 
Child 3: Does this
child have any
special needs? 
Child 3: Does this
child have a
car seat/booster seat? 
Yes  No 



Comments for Instructor 
* Required