Form Center

2. Request a car seat check and/or car seat
   The Sheriff's Office serves the rural townships of Scott County. If you live within city limits, please contact your local police department to schedule an appointment with them. Please complete the form below.
4. Today's Date*
   Today's Date
5. I am requesting

   1. A car seat installation check
   2. A car seat (you must qualify)
6. Do you live in a township or within city limits?

   The Sheriff's Office serves the rural townships of Scott County. If you live within city limits, please contact your local police department to schedule an appointment with them.

   1. Township
   2. City limits
   3. Unsure
8. First Name*
9. Last Name*
11. Phone Number*
12. Email Address*
14. Street Address*
16. City*
17. Best method to contact you?*

    1. Phone
    2. Email
18. Are you able to meet at a location in Scott County?*

    1. Yes
    2. No
20. Translator

    Will you need a translator?

    1. Yes
    2. No
21. Translator - language

    If you need a translator, for what language?

    1. Spanish
    2. Somali
    3. Russian
    4. Hmong
    5. Chinese
    6. Other (please specify in Comments/Questions field below)
22. Days/times that you are available*
    Please list what days/times you are available. Please not that if a seat is being provided by the county, the State of Minnesota requires that the parent/caregiver watch a video prior to the instructional phase of the appointment - please allow up to an hour and a half total for the appointment.
24. Child info that will be using the car seat:
26. Child(ren) age:*
27. Child Height:*
28. Child Weight:
30. Other info about your child(ren):
    Anything else that would be helpful (allergies, special needs, etc.)
32. Comments/Questions for us
34. Would you like to become a certified car seat technician?

    I am interested in being contacted in the future to attend a course to become a certified car seat technician

    1. Yes
    2. No

36. If you have any questions about car seat checks or car seats, please contact Community Engagement Deputy Amy Weckman at 952-496-8862 or email alueck@co.scott.mn.us.

Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field