Child Seat Inspection

2. 
4. First Name*
5. Last Name*
7. Phone Number*
8. Email Address*
10. All Child Seat Inspections will take place by appointment only at:
11. Orange County Sheriff's Office 110 Wells Farm Road Goshen, NY 10924.
13. Number of Child Seats to be Inspected*
    -- Select One --123456
14. Is the Child Seat(s) new in box?

    1. Yes
    2. No
16. Manufacture of Child Seat*
17. Model of Child Seat*
19. Manufacture of Child Seat
20. Model of Child Seat
22. Manufacture of Child Seat
23. Model of Child Seat
25. Year, make, & model of vehicle to be installed in*
26. A member of the Sheriff's Office will contact you by email or phone to setup a time and date for the Child Seat inspection.
28. 
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field