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2. Child Passenger Safety Inspection Request
4. You will be contacted to confirm the inspection once approved.
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip*
15. Phone Number*
16. Date of Request*
    Date of Request

    Date of Request
18. E-Mail Address
19. Preferred Method of Contact
    -- Select One --PhoneE-Mail
23. Requested Location of Inspection:*

    1. Fire Station 1 (301 W. Main St. Carrboro, NC 27510)
    2. Fire Station 2 (1411 Homestead Rd. Chapel Hill, NC 27516)
25. Requested Date and Time for Inspection*
    Requested Date and Time for Inspection

    Requested Date and Time for Inspection
26. Alternate Date and Time for Inspection*
    Alternate Date and Time for Inspection

    Alternate Date and Time for Inspection
28. Age of Child or Children:*

    Please enter the age or ages of your child or children. 

30. Approximate Weight of Child or Children:*

    Please enter the approximate or estimated weight of your child or children. 

32. Do you currently have a car seat or do you need a car seat?*

    1. Currently Have a Car Seat
    2. Need a Car Seat
    3. Other
34. If you currently need a car seat:

    The CFRD is unable to hold or reserve seats. Seats are distributed on a first come, first served basis. If the department does not have the type of seat needed the department will attempt to accommodate to obtain the correct seat through other agencies/distribution points. 

36. Additional Comments/Information
38. Note:

    This form is for requests for child passenger safety inspections. Requests are not received 24/7/365. Request submission does not guarantee the department will be able to provide the request service at the date and time requested. A representative from the fire department will contact you to confirm the request. Please contact (919) 918-7347 if additional assistance is required. 

Leave This Blank:


40. 1. Receive an email copy of this form.
41. Email address

    This field is not part of the form submission.

42. Submit

* indicates a required field