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. Upon receipt of your application, a staff member will contact you to schedule an appointment. 

   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
9. Appointment Day/Time

   Please select the best day/time of the week for your appointment. The CPSTs at the Municipal Court will do the best to accommodate your request. Please keep in mind you will need to bring the child and his/her car seat to the appointment. 

11. Day of Week*

    1. Tuesday
    2. Friday
12. Appointment Time*

    1. 9:00 am to 10:00 am
    2. 10:00 am to 11:00 am
    3. 3:00 pm to 4:00 pm
    4. 4:00 pm to 5:00 pm
16. Child #1
18. Child First Name*
19. Child Last Name*
21. Child Age*
22. Child Weight*
23. Child Height*
24. Do you have a good car seat for this child?*

    1. Yes
    2. No
28. Child #2
30. Child First Name
31. Child Last Name
33. Child Age
34. Child Weight
35. Child Height
36. Do you have a good car seat for this child?

    1. Yes
    2. No
40. Child #3
42. Child First Name
43. Child Last Name
45. Child Age
46. Child Weight
47. Child Height
48. Do you have a good car seat for this child?

    1. Yes
    2. No
50. 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.

54. Important Information regarding car seat inspection event

    Upon receipt of your application, a staff member will contact you to schedule an appointment. 

56. Phone Number*
57. Email Address*
Leave This Blank:


59. 1. Receive an email copy of this form.
60. Email address

    This field is not part of the form submission.

61. Submit

* indicates a required field