To register for a Car Seat Safety Check at Sunstar EMS Headquarters, 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 Headquarters is located at
12490 Ulmerton Rd
Largo, FL 33774
727-582-2068 or 727-582-2090
(Maps and Directions)

Appointment Date *

06/06/2013, 9:30AM - 2:00PM

08/01/2013, 9:30AM - 2:00PM

10/03/2013, 9:30AM - 2:00PM

12/05/2013, 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

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CME

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