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Request Car Seat Check and/or Car Seat

  1. 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.

    Scott County Sheriff’s Office provides car seats to families (when available) who are uninsured and in financial need. Please complete the online request above to apply for a car seat. 

  2. Financial Assistance*

    Are you receiving financial aid from Scott County?

  3. Case Worker*

    Are you assigned a case worker through Scott County?

  4. Car seat available though health care provider?*

    Have you already reached out to your prior health care provider and they are unable to provide a car seat to you?

  5. I am requesting
  6. Do you live in a township or within city limits?

    The Sheriff's Office primarily serves the rural townships of Scott County and the city of Credit River. 

    Do you live in a township or within city limits?

  7. Best method to contact you?*
  8. Are you able to meet at a location in Scott County?*
  9. Translator
    Will you need a translator?
  10. Translator - language
    If you need a translator, for what language?
  11. 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.
  12. Child info that will be using the car seat:
  13. Gender*

    Is the child a boy or girl?

  14. Anything else that would be helpful (allergies, special needs, etc.)
  15. 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
  16. Leave This Blank:

  17. This field is not part of the form submission.