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To register for a Car Seat Safety Check at the Lealman Fire District in St. Petersburg, please complete the form below.

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.

The Lealman Fire District is located at:
4360 55th Avenue North
St. Petersburg, Fl. 33714
For more information about this location please call (727) 526-5650 Ext. 22

Appointment Date * 
11/13/2014 Class 6:00-8:00 PM 
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

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

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