2022 Child Passenger Safety Week/Seat Check Saturday Car Seat Check Event Registration Form

Complete to register your Child Passenger Safety Week community event held during the week of September 18 - 24, 2022. Registered events will be compiled and shared, upon request for media releases. Events will be provided to PennDOT to share with NHTSA and posted on the PA TIPP website. PA TIPP does not need to be involved in the community car seat check events; we are merely compiling a list of all events to share with PennDOT, NHTSA and statewide community partners. If you are interested in receiving a list of events being held in Pennsylvania, please email aosterhuber@paaap.org. Thank you!

Question Title

* 1. What is the date & time of this event?

Start Time

Date

Time

AM/PM

End Time

Date

Time

AM/PM

Question Title

* 2. Event Location

Event Location *

Address: *

City: *

State:

ZIP/Postal Code: *

County: *

Question Title

* 3. Sponsoring Organization and Contact Information

Contact Name:

Organization:

Phone:

Email:

Question Title

* 4. Check whether appointments are required or walk-ins accepted.

Walk-Ins

Appointments Required

Appointments and Walk-Ins

Virtual Check By Appointment

Question Title

* 5. Make appointment with contact listed above?

Yes

Question Title

* 6. If no, who should be contacted for an appointment?

Name:

Phone:

Email:

Thank you for registering your community event. Please share the success of your event by completing the data collection form online at https://surveymonkey.com/r/CPSWeek2021Data or submitting the form found on the last page of the Child Passenger Safety Week 2021 Planner.