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2. Request An Appointment

   Appointments are for Golden Valley residents only and are scheduled a minimum of two weeks out. Your appointment is not scheduled until confirmed by the Golden Valley Police Department.

4. Name*

   Parent/Caregiver

6. Address*
8. City
9. State
10. Zip Code
12. Phone*
13. Email*
15. How many vehicles will be at the appointment?*
    -- Select One --12
16. Number of car seats to install*
    -- Select One --1234
17. Age(s) of your child(ren)*
19. Make and model of car seats*
21. Preferred Date And Time

    Appointments are available Tuesdays and Thursdays and last 30 to 45 minutes. Select possible dates and times that work for you. 

    Appointment availability is based on the Police Department's scheduling needs.

23. Tuesday

    1. 9 am
    2. 10 am
    3. 11 am
    4. 12 pm
    5. 1 pm
    6. 2 pm
24. Thursday

    1. 9 am
    2. 10 am
    3. 11 am
    4. 12 pm
    5. 1 pm
    6. 2 pm
25. Additional Information

    Please share anything else that would be helpful to know about this appointment.

27. Come Prepared*
    -- Select One --Yes, I will come prepared

    Help your appointment go smoothly by following these directions: 

    1. Clean out your vehicle and be sure staff is able to access the area in your vehicle where the seats are/will be installed. 
    2. Bring your car seat, manual for your seat(s), and a vehicle manual (if you have them). 
    3. If possible, bring the children who will be riding in the seat(s). 
    4. Your appointment is not set until you have received confirmation from a member of the Police Department. 
    5. Please take time to watch this video before your appointment – Simple Steps to Child Passenger Safety 2014 - YouTube.
Leave This Blank:


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

    This field is not part of the form submission.

31. Submit

* indicates a required field