Child Car Seat Educational Voucher Program

Fields marked with an asterisk (*) must be completed.

Child Car Seat Education Vouchers are supplied once only to residents and ratepayers.

* Have you been issued a voucher within the previous 12 months?:

• Yes
• No

* Acknowledgement:

• I acknowledge that I have read and agree to the Terms and Conditions

* Please advise if you require a safety check or installation of a child restraint:

• Safety check
• Installation

* Number of seats to be checked:

• 1
• 2
• 3

* Types of child seat(s):

• Capsule
• Rearward Facing Seat
• Forward Facing Seat
• Booster

* Age of child(ren):

• 0-1
• 1-2
• 2-4
• 4-10

* First Name:

* Last Name:

* Address:

* Please upload proof of residence:

* Phone number:

* Email:

* Make of Vehicle:

* Vehicle plate registration number:

Disclaimer:

By ticking this box, you agree to allow Council to send you follow up messages about our Child Car Seat Safety program.

• I agree