Thank you for your interest in child passenger safety.  The survey below should take about 10 minutes to complete.  It provides our child passenger safety technicians with important information to better understand your needs, as well as the amount of time required to complete your appointment.  After you have submitted the survey, we will review the information and contact you to schedule a specific date and time based on your calendar and our availability.  If you have any difficulty completing the survey, or have additional questions about our car seat program, please feel free to contact Safe Kids Sarpy/Cass directly at
rdysico@sarpycasshealth.com
Thank you for your patience and consideration.

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* 1.
We value your privacy as much as our own.  Safe Kids Sarpy/Cass will never sell or share the information you provide on this survey.  Our child passenger safety technicians will only use it to schedule your installation appointment.  If you would like to receive occasional emails or texts messages with information on Safe Kids Sarpy/Cass events, safety campaigns, and free resources you may opt in below.


For scheduling purposes - please enter the best contact information to reach you

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* 2. How did you hear about our car seat program?

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* 3. Have you, or have any of your immediate family members, ever served in the military?

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* 4. Do you receive state or federal aid and are in need of a car seat?  Some examples are Medicaid, WIC, SNAP

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