the child accident prevention foundation of australia

Fitting or Checking Enquiries

For enquiries or further information, please complete the form below and someone will be in touch with
you shortly. So that we can respond to your query promptly, please ensure that all fields marked with an
* asterisk are complete.

If you require an appointment within the next two weeks, please contact the office directly on
(08) 9340 8509. (Kidsafe WA recommends that you book appointments at least two weeks prior
to your due date).

First Name	*
Last Name	*
Postcode	*
Email Address	*
Phone	*
Mobile
Vehicle Details
Make/Model
Year of Manufacture
Registration Number
Child Size	Child not yet born
	Child 1 Weight
	Child 1 Age
	Child 2 Weight
	Child 2 Age
	If more than 2 children add details in comment box below.
Preferred Time of Day for Appointment	*
Preferred Day of the Week for Appointment
Restraint Details: (Please provide Make & Model Name, and whether New or 2nd Hand)
Additional Comments/Questions
How did you find us?
If other, please specify
	Subscribe to: Kidsafe Newsletter