Official Boxborough, MA Fire Department Website

Boxborough Fire Department

Child Passenger Safety Request Form

Boxborough Fire:

Lieutenant Shawn Gray (sgray@boxboroughfire.com)

Lieutenant Jason Malinowski (jmalinowski@boxboroughfire.com)

Boxborough Police:

Patrol Officer Patrick Colburn (colburn@boxboroughpolice.com)

The Child Passenger Safety Program is designed to help educate parents on the proper installation of car or booster seats in their cars. The program also focuses on ensuring that each child is utilizing a seat that is free of defects, recalls, and is appropriate for the height and weight of the child.

Reservations are required and no walk-ins will be accepted, as each Child Passenger Safety Technician must prepare separately for the installation. Reservations are available seven days a week, and are dependent on each technician's schedule. Please plan for an appointment of an hour.

What to Bring:

1) Vehicle Manual

2) Car Seat Manual (for each seat being installed)

3) Children that will be restrained in each seat

First Name

Last Name

Street Address

Address (Con't)

Contact Phone

E-mail Address

Requested Date/Time

Please plan for an hour for an installation.

First Preference Class Date:

Second Preference Class Date:

Third Preference Class Date:

Preferred Time of Day (AM, PM):

Vehicle 1 Information

Please provide as many details as you can about the vehicle that you will be bringing.

Make of Car (ex. Ford, Toyota, Lexus):

Model Year:

Model (ex. Explorer, Camry, RX350)

Vehicle 2 Information (if applicable)

Please provide as many details as you can about the vehicle that you will be bringing.

Make of Car (ex. Ford, Toyota, Lexus):

Model Year:

Model (ex. Explorer, Camry, RX350)

Car Seat 1 Information

Please provide as many details as you can about the car seat that you will be bringing.

Make of Car (ex. Graco):

Date of Manufacture:

Model Number:

Age of Child Going in Seat:

Weight of Child:

Height of Child:

Car Seat 2 Information (if applicable)

Please provide as many details as you can about the car seat that you will be bringing.

Make of Car (ex. Graco):

Date of Manufacture:

Model Number:

Age of Child Going in Seat:

Weight of Child:

Height of Child:

Car Seat 3 Information (if applicable)

Please provide as many details as you can about the car seat that you will be bringing.

Make of Car (ex. Graco):

Date of Manufacture:

Model Number:

Age of Child Going in Seat:

Weight of Child:

Height of Child:

Special Requests (Additional Seats, Specific Date/Time, etc.):