Lakewood Ranch Car Seat Registration

To register for a Car Seat Safety Check at All Children's Outpatient Care, Lakewood Ranch, please complete the form below.

8340 Lakewood Ranch Blvd., Suite 160
Bradenton, FL 34202
(Find us under Women's Center carport)

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 * 
10/07/2014, Check (have your own car seat): 10:30AM 
10/07/2014, Check (have your own car seat): 11:30AM 
10/07/2014, Class (qualify for a car seat): 10:00AM 
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