Arlington County: Police Child Safety Seat Registration

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You must be an Arlington resident to make an appointment for an inspection of your child safety seat.

Note: Asterisks (*) indicate required fields.

Contact Information

*Email:

*First Name:

*Last Name:

*Address:

*Telephone #:

Registration

*Preferred inspection date:

*Relationship to Child:
Parent or Guardian Grandparent
Other

Child's Age:

Weight (lbs):

Height (inches):

If you are a expecting mother, enter due date:

Vehicle and Seat Information

First Vehicle Information Make: Model: Year: Safety Seat Information First Safety Seat* Seat Type: Manufacturer: Model: Second Safety Seat* Seat Type: Manufacturer: Model: Third Safety Seat Seat Type: Manufacturer: Model:		Second Vehicle Information Make: Model: Year: Safety Seat Information First Safety Seat Seat Type: Manufacturer: Model: Second Safety Seat Seat Type: Manufacturer: Model: Third Safety Seat Seat Type: Manufacturer: Model:
Comment:
Note, this form accommodates only two vehicles and up to three seats per vehicle. If you need more inspected, please submit a separate form.