Better Safe Than Sorry Unbuckled Child Reporting Form

Did the incident occur in Washington State?
Yes No

Incident location (Street, Intersection & Town / County or Highway / Freeway with location):

Incident Date:
 Incident Time:


Vehicle description (Make, Model, color, etc...): (Required)



License Number: (Required)


State in which plate is from: (Required)


What did you observe that makes you think there was an unbuckled child? (Required)

Your E-mail Address: (Required)