Child Car Seats are installed by appointment only. Appointments are available during morning hours. Afternoon appointments are not available. Please fill out the form below and our Car Seat Liaison will contact you within 3-7 days to schedule your installation appointment.

Please direct any questions to Debbie Gendrau at 954-828-6800 or dgendrau@fortlauderdale.gov.

1

Last Name

 *

Last Name

2

 First Name

 *

First Name

3

Phone Number

 *

ext.Phone Number

4

Phone Number (Please reenter phone number)

 *

ext.Phone Number (Please reenter phone number)

5

Email

 *

Email

6

Date you are requesting for Car Seat to be installed.  

Date you are requesting for Car Seat to be installed.

7

Please provide alternative dates for installation in case the initial request date is not unavailable.

Please provide alternative dates for installation in case the initial request date is not unavailable.

Please provide alternative dates for installation in case the initial request date is not unavailable.

Please provide alternative dates for installation in case the initial request date is not unavailable.

Please provide alternative dates for installation in case the initial request date is not unavailable.

8

Baby due date.  If not applicable please note in the second field N/A.

Baby due date. If not applicable please note in the second field N/A.

Baby due date. If not applicable please note in the second field N/A.

Baby due date. If not applicable please note in the second field N/A.

9

Car Seat Make

 *

Car Seat Make

10

Car Seat Model

 *

Car Seat Model

11

How many seats do you need to be installed

How many seats do you need to be installed

12

Child's Age

Child's Age

13

Child's weight

Child's weight

14

Child’s height

 *

Child’s height

15

Comments

Comments

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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