Faculty/Staff
University of Missouri Homepage
Print    Email
Decrease (-) Restore Default Increase (+) font size
Email Forms Manager


Make an appointment request to receive your Kohl's Safety Store products by filling out the form below.

Appointments are available most Saturdays of the month from January through December between 9 a.m. and 11 a.m.

Appointments are 30 minutes and are designed to help you learn about the new product and how to operate/install it properly.

For more information about the Kohl's Safety Store, contact Sheila Robertson, coordinator of Pediatric Injury Prevention and Safety Outreach, at (573) 875-9216.



* Indicates required information
First Name * 
Last Name * 
Street Address 1 * 
City * 
Zip * 
County * 
Phone Number * 
Email Address 
Check which product you need * 

If you selected car seat, what is your child's weight, height and age? 
Weight in pounds 
Height in inches 
Age 
Which are you requesting 

Which 4th Saturday of the month works best for you? * 
Select which appointment time works best for you * 
If we have questions or need to reach you about your appointment time, what is the best time of day to do so? 


What is your preferred way to be contacted 
 



Human Resources Giving Disclaimer Notice of Privacy Practices Web Communications Social Media Site Index
Mizzou University of Missouri University of Missouri System