Wauwatosa residents can request an appointment to have a car seat checked in their vehicle at the Wauwatosa Health Department, located at 7725 W. North Avenue. Appointments are available between 9 a.m. - 3 p.m., Monday - Thursday. 

If you are interested in scheduling an appointment, please complete this form.

1

Your Contact Information:

 *

Your Contact Information:

Name

Street Address

City

State

Zip code

Phone Number

Email Address

2

List appointment attendees and preferred dates/times:

 *

List appointment attendees and preferred dates/times:

3

Enter the child's information:

 *

Enter the child's information:

Age

Due date (if applicable)

Height (if applicable)

Weight (if applicable)

4

Enter vehicle information:

 *

Enter vehicle information:

Year

Make

Model

Color

5

Enter car seat information:

 *

Enter car seat information:

Name of car seat

Manufacturer

Model number

Date of manufacture/age of car seat

6

List the average number of passengers and car seats in the vehicle:

 *

List the average number of passengers and car seats in the vehicle:

Passengers

Car seats

7

Are you the original owner of this car seat?

Are you the original owner of this car seat?

Yes

No

8

Has this car seat been involved in a crash?

Has this car seat been involved in a crash?

Yes

No

9

Do you have the car seat manual?

Do you have the car seat manual?

Yes

No

10

Is the car seat labeled meeting federal standards?

Is the car seat labeled meeting federal standards?

Yes

No

11

 Is your car seat:

Is your car seat:

Rear facing

Forward facing

Booster with a back

Booster with no back

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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