Intake Form – Car Seat Guru

Thank you for booking your appointment. I look forward to meeting with you.

In order to save time and minimize physical contact and “paperwork”, please complete and submit the below information before your appointment, thank you.

Note:

All car seat checks are documented; the inspection form may be emailed to you after your appointment by request
Fields required are marked *
Payment methods accepted: e-transfer or cash
To reschedule or cancel, please text or call at least two hours before your scheduled appointment

Your Name *

First

Last

Your Email *

Your Phone Number

Confirmed Appointment Date and Time *

If you do not have a confirmed appointment, please use the Appointment request form instead

Vehicle Info (Year, Make, Model) - one per line *

Child's Info (Age or DOB, Weight, Height) - one per line *

Car Seat Info (Make, Model) - one per line *

Additional Notes and Comments

Review Waiver *

Waiver read and accepted
Please cancel my appointment

I understand and agree that the primary purpose of a car seat check appointment is to help reduce the incidence of improper use of child car seats.

Information is being provided as a service to me and is not intended to evaluate the quality, safety or condition of my child car seat or any component of my vehicle including the seats or seat belts.

It is not intended to provide legal or professional advice or to be relied on in a dispute, claim, action demand or proceeding. The information provided cannot guarantee a child's safety in a collision.

I also understand that Child Passenger Safety Technicians (CPSTs) accept no responsibility for any loss, damage, injury or expense that may be suffered by me, or a child for whom I act as guardian arising from using a child car seat.

In consideration for allowing me to participate in this service, I hereby release the CPST from any and all actions, causes of actions, claims and demands of any nature whatsoever in any way arising from my participation in the appointment.

I agree that this waiver be effective and binding upon my heirs, next of kin, executors, administrators and assigns.

Health Measures *

Masks not necessary
We would prefer to wear masks

Please let me know if you'd prefer that all attendees wear masks during our appointment