Kiowa Tribe Injury Prevention Program
P.O. Box 369
Carnegie, OK 73015
(580) 654-2300 ext. 379
Car Seat Application
Name: __________________________________________________________________
Parent or Legal Guardian
Address: ________________________________________________________________
P.O. Box or Street
________________________________________________________________________
City State Zip Code
Phone Number: ( )
Name and Age of Child/Children:
________________________________________________________________________
Name Age Weight DOB Tribe & Roll Number
________________________________________________________________________
Name Age Weight DOB Tribe & Roll Number
Brand of Car/Booster Seat Make/Model of Car/Booster Seat Date of Manufacture
The Kiowa Tribe Injury Prevention Program will not be held liable for the improper use
of car or booster seats given by the program. The Injury Prevention Program will not be
responsible for any damages that occur due to faulty car/booster seats. It is the
responsibility of the child’s/children’s caregivers to ensure all car/booster seats are
properly installed each time they are used.
________________________________________________________________________
Signature of Applicant Date
5 Common Mistakes Made When Installing Car/Booster Seats
1. The car seat is installed too loosely in the vehicle – Your car seat should not move
more than one inch side to side or forward. This is the number one mistake that parents and
caregivers make
The danger: In a collision, a child in a loose seat could crash into the back of the front seat
and seriously injury their face or head.
How to fix: Place your knee in the seat and put all your weight into it (use your arm for
an infant seat), tightening the seat belt as much as possible. Then lock the seat belt, a step
that many parents miss. If you have a pre-1996 car, it may not have adequate belt-locking
capabilities. You will need to use a locking clip. Most safety seats come with one. Do not
forget to engage your car’s seat belt lock. Shoulder-belt locks work differently than lap
belt locks, so check your car manual for instructions.
2. The car seat is turned forward facing too soon – Infants should ride rear facing
until they are at least one year of age and 20 – 22 pounds.
The danger: The bones that protect an infant’s spinal cord are still forming. When a
child is rear facing, his/her back (the strongest part of their body) can better absorb the
immense forces of a crash. Facing forward, an infant’s relatively heavy head can catapult
forward. This may cause his/her underdeveloped spine to expose the spinal cord, putting
him/her at risk of paralysis or death.
How to fix: Follow the rules. Keep your baby rear-facing until at least one year of age and
at least 20 pounds. Go the “extra mile” and keep your child rear facing until he/she reaches
the upper weight limit of the safety seat and is at least one year of age.
3. The harness is loose and the retainer clip is not correctly positioned on the
child – The harness should be snug on the child’s shoulders and the retainer clip should
always be positioned at armpit level.
The danger: A child who has a loose harness can easily come out of the safety seat in a
crash. The child could then be severely injured if they hit part of the cars interior or
another passenger. When the retainer clip is in the wrong position, the straps can easily slip
off the child’s shoulder and put the child at risk of being ejected from the seat during an
accident.
How to fix: Tighten the harness. Keep in mind that the straps should be snug and have no
slack. Parent often move the retainer clip as they maneuver their child out of the seat.
Check the clip’s position every time you buckle up.
4. The harness straps are not properly threaded or adjusted – Harness straps
should be at or below the child’s shoulder when using a car seat rear facing. When using a
car seat in the forward facing position, harness straps should be at or just above the
shoulders, usually the top slots, unless manufacturer’s instructions say differently.
The danger: When the child faces forward, a harness in the lower slots can break through
the seat during a collision.
How to fix: Always check the instructions that came with your seat to find out which slots
are for which direction. If in doubt, call the manufacturer of the child safety seat. The 1-800
number should be on the side of your child’s seat.
5. The child is not in a booster seat long enough or not in one at all – Booster seats
are for kids who weigh between 40 – 80 pounds and up to 4’9”tall. Usually four to eight
years old. A booster seat boosts the child up so the seat belt fits the child correctly; low over
the hips and upper thighs and snug over the shoulder.
The danger: An adult seat belt used by itself does not properly restrain a child because it
crosses the body at the wrong position, high on the belly, high across the shoulder, and
sometimes even across the neck. Children often move the shoulder belt behind them because
it’s uncomfortable. In a crash, a child who is too small for an adult seat belt can sustain
massive internal organ damage, head and spinal injuries, or even be ejected.
How to fix: If your child is 40 – 80 pounds and up to 4’9” tall, make sure they are in a
booster seat.
Take the 5 step test:
1. Child sits upright with their buttocks against the back of the vehicle seat.
2. Knees bend naturally at the edge of the seat.
3. Shoulder belt fits across the mid point between their neck and shoulder.
4. Lap belt fits across the upper thighs and lower hips.
5. Child is mature enough to ride in this position the entire car ride.