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NPD Child Safety Seat Sign-Up Form

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Once submitted, a Noblesville Police Department officer will contact you to schedule an appointment. You must be a resident of the City of Noblesville.

* Denotes a required field

Contact Information

Full Name*

If you don't live in Noblesville, please seek out your local law enforcement agency near you for this service.

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Telephone/Cell Phone Number*

Phone Area Code-Phone 3-Phone 4 ext Extension

E-mail Address*

Child Information

Child's Age*

Child's Height*

Child's Weight*

If you have additional children, please add their ages, heights and weights below in the additional information box.

Vehicle Information

Vehicle Year*

Vehicle Make*

Vehicle Model*

If you have additional vehicles, please add the vehicle year, make and model below in the additional information box.

Child Safety Seat Information

Number of Child Safety Seats in Vehicle*

Seat Manufacturer Name*

Child Safety Seat Model Name/Number*

Seat Date of Manufacture (Printed on label on side of seat)*

If you have additional child safety seats, please add the manufacturer name, model name/number and date of manufacture in the additional information box.

Please Do Not Complete The Following Field

Appointment Type Requested

Type of Inspection*

Additional Information you'd like to add:

NPD Child Safety Seat Sign-Up Form

Contact Information

Child Information

Vehicle Information

Child Safety Seat Information

Appointment Type Requested

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