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Booster Seat Application 2018

APPLY FOR SEATS

ELIGIBILITY REQUIREMENTS:
- You must pre-register and be approved to receive a new free booster seat
- Must be a low-income resident of Alameda County
- Child to receive booster seat must meet the following:
  • Attend event with parent/guardian
  • Be at least 5 years old
  • Weigh between 50 - 100 pounds
  • Be between 40 - 57 inches tall
- Parent/Guardian's vehicle must be present to install booster seat
- All booster seats MUST be picked up on Saturday, June 23 by 12pm
- Two children per family may receive a booster seat. 
- You can only submit one application. If you submit more than one, your application will not be processed.
- SUBMISSION OF APPLICATION DOES NOT GUARANTEE SELECTION FOR A BOOSTER SEAT
- APPLICATIONS MUST BE SUBMITTED NO LATER THAN WEDNESDAY, JUNE 6


Note: If your child does not meet the above booster seat requirements, visit http://www.acphd.org/ipp/cip/cps.aspx. More than 95% of all children’s car seats are installed and used incorrectly in Alameda County. If you have a child or children who are traveling rear-facing or forward-facing in a harness car seat, be sure to have your seat checked by a certified car seat technician at one of our many partner locations throughout Alameda County.
1. Please provide the following contact details.
This question requires a valid email address.
2. Please choose one of the following:  *This question is required.
3. How many booster seats are you applying for?   *This question is required.
4. What is your annual income?
5. Please complete the following information for Child 1. *This question is required.
Gender *This question is required.
How much does your child weigh? *This question is required.
How tall is your child? *This question is required.
6. Copy of Please complete the following information for Child 2.
Gender
How much does your child weigh?
How tall is your child?