Car Seat Assistance

The mission of Safe Kids is to prevent unintentional injuries, the leading cause of death and disability in children. Each year, an estimated 4 million Florida  children (1 out of 4), ages 14 and under, will experience injuries serious enough to require medical attention.

If you are not able to purchase a car seat, please fill out this application.

There is a maximum number of 10 free car seats per class.

Safe Kids Southwest Florida Car Seat Qualification Form

Please use this form to apply for a free car seat from Safe Kids Southwest Florida.
Someone will be in touch with you soon to discuss your application.
Thank you, The Safe Kids Team
  • Safe Kids Southwest Florida
    Golisano Children's Hospital of Southwest Florida
    9981 S. HealthPark Dr., Suite 456
    Fort Myers, FL 33908
    Phone: 239-343-6199
    Fax: 239-343-6492
    Sally.Kreuscher@LeeHealth.org
  • ABOUT THE PARENT/CAREGIVER

    Please provide your information so that we may process your application for a free car seat from Safe Kids Southwest Florida. As a parent, caregiver, guardian, grandparent, foster parent or designee, you may qualify for a child safety seat for your eligible child(ren), dependent(s), or those for whom you provide care, including transportation on a regular basis. If you or any of your household dependents self-certify that you are 100% poverty level, as defined by the U.S. Department of Health and Human Services’ Poverty Guidelines (See Below), and are unable to afford to purchase a child safety seat for your child(ren), dependent(s) or child(ren) in your care at this time, you may receive assistance. The maximum number of free car seats PER CLASS is 10. You will be notified if the class you enrolled in is full. However, if the family has their own seat and would like to come for the education, there is no max to attendees.
  • Car Seat Guide
    Choose the type that matches the type of car seat as it is shown above.
  • ABOUT THE CHILD

    Please provide information on the child that will receive the new car seat.
  • ABOUT THE VEHICLE

    Please answer these questions to give us more information on the vehicle which will hold the car. How many people in each of the following age groups ride in the family car? 
  • Poverty Level

 

 

 

This program is generously supported by Hertz