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Car Seat Basics Registration

Welcome

Thank you for taking the time to register and learn about child passenger safety.
1.Are you a Carroll County Resident?(Required.)
2.Caregiver Name(Required.)
3.Caregiver Address(Required.)
4.Caregiver Phone Number(Required.)
5.Caregiver Email Address(Required.)
6.Are you WIC or Medicaid eligible (you do not have to be currently enrolled)?(Required.)
7.Where did you hear about us?(Required.)
8.Are you currently pregnant?(Required.)
9.Are you in need of a car seat or booster seat?(Required.)
10.If your child needs a car seat or booster seat, please fill out the information below
Next Steps:
*You will receive a car seat education email
*In this email there will be a link to access the carseat education training
*The Password to access the course will be CPS12345 (Please write this down for future use).
*Once you have successfully completed the training and are in need of a car seat contact CCGHD to receive your free car seat.

If you have any questions car seat safety questions please contact Amy Campbell at the Carroll County General Health District at 330-627-4866 ext. 1557.