Official Car Seat Fitting Station

Car Seat Fitting Information

The State of Delaware requires us to obtain certain information pertaining to a car seat safety inspection or fitting. By completing this form, we will have streamlined the process and the time you need to spend filling out the paperwork manually.

In addition to saving time, the information you provide will allow us to search for any recalls pertaining to your car seat. We will present all findings to you at the time of the fitting.

Thank you,
Greg Buckley
President, Buckley's Auto Care

Personal Information

First Name *

Last Name *

Phone Number (no spaces) *

Email Address *

Is This Your First Fitting With Us?

Yes

No

How Did You Hear About Us? *

Address

Your Current Street Address *

Address Line 2

City *

State *

Zip Code *

Vehicle Information

**It is required to have your Vehicle Owner's Manual Present During Training

Vehicle Year *

Vehicle Make *

Vehicle Model *

Current Mileage (approximate)

Vehicle Identification Number *

License Plate Number (optional)

Child Fitting Information

Select Fitting Type *

Reason For Fitting *

Number Of Children Transported *

Please Detail Child Age, Weight, Height

	Age	Weight	Height
First Child	Age	Weight	Height
Second Child	Age	Weight	Height
Third Child	Age	Weight	Height

Car Seat Information

Car Seat Make *

Car Seat Model *

Model Number

Car Seat Age

Is This Seat Second Hand or a Hand Me Down? *

Yes.

No.

How Many Children Will Be Attending?

Appointment Request

Appointment Type

New Appointment

Confirm an Existing Appointment

Preferred Appointment Date +

Alternate Appointment Date +

Please Indicate Appointment Date And Time +

Please Select Your Time *

Child Seat Fitting Adjustments. Please confirm by checking the box.
*

Child Car Seat Safety Adjustments Available. NO CHARGE. Participant will be trained by a Nationally Certified Safety Seat Technician on how to properly install and maintain a standard child safety seat. The time required is approximately 20 - 30 minutes. This is for individuals that may have their seats already installed and only need confirmation or an understanding of how to properly fit the safety seat.

PREMIUM Service: $34.95 Our premium service is designed for parents and others needing to have a completely new child safety seat installed. We include a 1 Hour, fully private, one to one training session with a National Certified Child Passenger Safety Seat Technician. In addition to installation and/or fitment, a Digital Inspection of your car seat fitment so that you have a permanent reference. You will leave the session fully confident of your ability to properly install or adjust your child's safety seat when necessary.

Current Total:

$0.00

PLEASE SIGN RELEASE FORM: I understand and agree that the sole purpose of this program is to help reduce the incidence of the improper installation of child safety seats through means of education and hands on instructions: that this training is being provided to as a service to me; that this program cannot fully evaluate the quality, safety, or condition of my car safety seat or any component of my vehicle, including the seats or safety belts; and that this program and service performed by Buckley's Auto Care cannot guarantee my child's safety in a vehicle collision. I understand that it is important to read and follow the instruction manuals for both the vehicle and the car seat. For these I hereby release Safe Kids Worldwide and each of the Safe Kids coalitions; Buckley's Inc. and each of its divisions, subsidies and other operating entities: and any program participants from any present or future liabilty for any injuries or damages that may result from a vehicle collision or otherwise. *

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Please click the SUBMIT BUTTON below to send your information.

Thank You