City of Victoria Form Center

2. Car Seat Inspection Registration
   The City of Victoria has designated Child Passenger Safety Technicians (CPST) that can inspect child passenger seats for proper installation and provide educational information to caregivers. To schedule an appointment for a car seat inspection, please fill out this form. 

   For more information, please call 361-485-3050 or e-mail csprogram@victoriatx.gov.
4. Parent or Guardian First Name*
5. Parent or Guardian Last Name*
7. How did you hear about this program?*
   -- Select One --FacebookVictoria Housing AuthorityFriend or family memberOther
11. Child #1
13. Child First Name*
14. Child Last Name*
16. Child Age*
17. Child Weight*
18. Child Height*
19. Do you have a good car seat for this child?*

    1. Yes
    2. No
23. Child #2
25. Child First Name
26. Child Last Name
28. Child Age
29. Child Weight
30. Child Height
31. Do you have a good car seat for this child?

    1. Yes
    2. No
35. Child #3
37. Child First Name
38. Child Last Name
40. Child Age
41. Child Weight
42. Child Height
43. Do you have a good car seat for this child?

    1. Yes
    2. No
45. Fill out this section if you have additional children you will be bringing to the event for the car seat inspection..

    Please include name, age, weight, and height for any additional children.

49. Phone Number*
50. Email Address*
Leave This Blank:


52. 1. Receive an email copy of this form.
53. Email address

    This field is not part of the form submission.

54. Submit

* indicates a required field