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Kohl's Buckle Up
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Injury Prevention and Safety Outreach Events
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Make an appointment request to receive your Kohl's Safety Store products by filling out the form below.

Appointments are available every 4th Friday of the month (except the 5th Friday in May and 3rd Friday in November) from January through November 2014 from 3 to 5:30 p.m. Every attempt will be made to accommodate your appointment request.

Appointments are 30 minutes and are designed to help you learn about the new product and how to install and operate 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 
Which are you requesting? 

Select your date * 
Select your appointment time * 
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? * 

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