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
8. Please select time of day that works best for an appointment.*

   1. Morning (8:00 am to 11:00 am)
   2. Late afternoon (3:00 pm to 5:00 pm)
12. Child #1
14. Child First Name*
15. Child Last Name*
17. Child Age*
18. Child Weight*
19. Child Height*
20. Do you have a good car seat for this child?*

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

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

    1. Yes
    2. No
46. 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.

50. Important Information regarding car seat inspection event

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

52. Phone Number*
53. Email Address*
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field