Family Vehicle Safety Program Court Requirements - Las Vegas
[Pages:1]Family Vehicle Safety Program
Court Requirements
(For child restrain violation NRS 484.474)
FEE: $50.00 per Charge
CASH ONLY (Exact Change)
BRING CAR SEAT TO CLASS NO CHILDREN PLEASE
Safe Kids Buckle Up Child Passenger Safety
Offender Program
(702) 731-8666
Must call to register
This form must be completed and returned to the Court NO LATER Than
__________________
UNLV Child Safety Classes
(702) 895-1780
Call to register or Register On-line at pedsafe.vegas/child-safety-classes
Judge: Chief Judge Cynthia Leung Case #: ___________________ DL #: __________________________
Court: Las Vegas Municipal Court Defendant's Name: _________________________________________ DOB: __________________________
Defendant's Statement Class size is limited and space must be reserved TEN days in advance. Contact an agency listed above for class time and dates. You MUST bring a car seat to class that is appropriate for the size and weight of the child you were driving when you received the ticket. Present this form to the Instructor, who will WITNESS YOUR SIGNATURE and sign below upon your completion of the course.
I agree to attend a car seat education program, have my car seat checked in my vehicle, and present this signed completion form to the Nevada court on or before the due date specified by the court. I understand that I may not attend the class while under the influence of drugs or alcohol.
Defendant Signature: __________________________________________ Date: _________________ Witness Initials: ________________
(DO NOT WRITE BELOW THE LINE)
Class Date: ____________________________
COURSE COMPLETION
Location/Agency: ______________________________
Amount Paid: ______________________
I verify that the above named defendant completed a program of training in the installation and use of child restraint systems, and that the defendant departed the training with a properly installed child restraint system that is appropriate for the size and weight of the child being transported at the time they received the ticket.
Instructor Name: ______________________________________
CPS Tech/Instructor #: ______________________
Instructor Signature: ___________________________________
National Safe Kids Certification Other Certifying Body
Revised: 6-20-17
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