Community Programs Car Seats Car Seat Class: East Lake

Car Seat Class: East Lake

To register for a Car Seat Safety Check at All Children's Outpatient Care, East Lake, please complete the form below. If you are registering more than three children, you must sign up for more than one time slot because more time will be needed.

All Children's Outpatient Care, East Lake is located at 3850 Tampa Road, Palm Harbor, FL 34684. Get maps and directions.

Appointment Date * 
06/07/13, 09:00 AM Class (qualify to purchase a car seat): 
06/07/13, 11:00 AM Check (have your own car seat): 
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
Creating healthy tomorrows... for one child, for All Children.
501 6th Avenue South, St. Petersburg, FL 33701
Phone: 727-898-7451 Toll-Free: 800-456-4543 info@allkids.org
Copyright © 2013 All Children's Hospital, a member of Johns Hopkins Medicine. All rights reserved.