Car Seat Class: Sunstar EMS South Hub

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All Children's Hospital
501 6th Ave South
St. Petersburg, FL 33701
(727) 898-7451
(800) 456-4543

	Car Seat Class: Sunstar EMS South Hub

To register for a Car Seat Safety Check at Sunstar EMS South Hub, 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.

The Sunstar EMS South Hub is located at
2155 14 Circle N
St. Petersburg, FL 33707
727-582-2068 or 727-582-2090
(Maps and Directions)

Appointment Date *

05/18/2013, 9:30AM - 2:00PM

07/20/2013, 9:30AM - 2:00PM

09/21/2013, 9:30AM - 2:00PM

11/16/2013, 9:30AM - 2:00PM

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

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

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

Comments for Instructor

* Required