Check Up Registration Link for October 6, 2022 from 2pm-6pm

Welcome to the registration page for your car seat check-up appointment. Please complete the entire form or you will not be able to schedule the appointment. We will email you the week prior if the scheduled time is convenient or if we need to select an alternate time. We will make every effort to get you in for the time requested. Also be advised that if you have multiple children then the appointment may take longer so be prepared to wait. We will need for the child to be present to ensure that we are providing the appropriate car seat for your child. Please note that if you have a car seat replaced that we need to dispose of the old seat. Thank you to our community partners Transurban and State Farm for the donating replacement car seats for our families in need. 

If you have questions or need additional information, please contact Linda Watkins at 703-776-3259 or email me at linda.watkins@inova.org

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* 1. Parent Name

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* 2. What is your street address?

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* 3. Phone Number

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* 4. Child 1 Name

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* 5. Age

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* 6. Height

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* 7. What is child's current weight in pounds?

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* 8. Child 2 Name

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* 9. Age

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* 10. Height

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* 11. What is the child's current weight in pounds?

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* 12. Child 3 Name

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* 13. Age

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* 14. Height

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* 15. What is the child's current weight in pounds?

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* 16. Parent Email address

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* 17. Requested appointment time

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