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Car Seat Clinic Registration form
Thursday, April 24, 2008
Scott-Preusse Service Garage in Redwood Falls
4pm-8pm

Please fill out the entire form below.  Appointments will be taken on a first-come first-served basis.  Please use the following guide to help you make your appointment.

If you have two or more children you will need to make multiple appointments for the number of children you have.  Each child takes 1/2 hour. 

Example: You have one 18 month old child and one 5 year old child.  Make and appointment for Lane 1 at 4:00pm for the 18 month old and for Lane 1 at 4:30pm for the 5 year old.  Your children need to be scheduled for the same lane (unless the option is not available, but do not schedule 2 children for the same time). 


Parent/Grandparent Information:
First Name:     Last Name: 
Address:   
City:    State:           Zip:        
Home Phone:
Cell Phone:
*Email Address:
Select one: Parent
                 Grandparent

Appointment Information
Name of child 1:  
Age of child 1:  
Weight of child 1 (please weigh for current weight):  
Height of child 1 (in inches):  
Appointment Time:

Name of child 2:  
Age of child 2:  
Weight of child 2 (please weigh for current weight):  
Height of child 2:  
Appointment Time (do not select the same time as child 1):

Name of child 3:  
Age of child 3:  
Weight of child 3 (please weigh for current weight):  
Height of child 3:  
Appointment Time (do not select the same time as child 1 or 2):

Name of child 4:  
Age of child 4:  
Weight of child 4 (please weigh for current weight):  
Height of child 4:  
Appointment Time (do not select the same time as child 1, 2 or 3):
 

Please be at the back entrance of the service garage 10 minute prior to your appointment time.
 Car Seat Clinic in Redwood Falls, MN

 

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100 Fallwood Road ~ Redwood Falls, MN 56283
507-637-4500

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