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.

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 * 
09/20/14, 09:00 AM Check (have your own car seat or obtain low cost seat) @ Dick Norris Buick GMC 18200 US Hwy 19 N, Clearwater, FL 33767 
09/20/14, 09:30 AM Check (have your own car seat or obtain low cost seat) @ Dick Norris Buick GMC 18200 US Hwy 19 N, Clearwater, FL 33767 
09/20/14, 10:00 AM Check (have your own car seat or obtain low cost seat) @ Dick Norris Buick GMC 18200 US Hwy 19 N, Clearwater, FL 33767 
09/20/14, 10:30 AM Check (have your own car seat or obtain low cost seat) @ Dick Norris Buick GMC 18200 US Hwy 19 N, Clearwater, FL 33767 
09/20/14, 11:00 AM Check (have your own car seat or obtain low cost seat) @ Dick Norris Buick GMC 18200 US Hwy 19 N, Clearwater, FL 33767 
10/14/14, 10:00 AM Class (qualify to obtain a car seat OR 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