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Time zone
(UTC-12:00) International Date Line West
(UTC-11:00) Coordinated Universal Time-11
(UTC-10:00) Hawaii
(UTC-09:00) Alaska
(UTC-08:00) Tijuana, Baja California
(UTC-08:00) Pacific Time (US and Canada)
(UTC-07:00) Arizona
(UTC-07:00) Chihuahua, La Paz, Mazatlan
(UTC-07:00) Mountain Time (US and Canada)
(UTC-06:00) Central America
(UTC-06:00) Central Time (US and Canada) (Form default)
(UTC-06:00) Guadalajara, Mexico City, Monterrey
(UTC-06:00) Saskatchewan
(UTC-05:00) Bogota, Lima, Quito
(UTC-05:00) Eastern Time (US and Canada)
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(UTC-04:00) Asuncion
(UTC-04:00) Atlantic Time (Canada)
(UTC-04:00) Caracas
(UTC-04:00) Manaus
(UTC-04:00) Georgetown, La Paz, San Juan
(UTC-04:00) Santiago
(UTC-03:30) Newfoundland and Labrador
(UTC-03:00) Brasilia
(UTC-03:00) Cayenne
(UTC-03:00) Buenos Aires
(UTC-03:00) Greenland
(UTC-03:00) Montevideo
(UTC-02:00) Coordinated Universal Time-02
(UTC-02:00) Mid-Atlantic
(UTC-01:00) Azores
(UTC-01:00) Cape Verde Is.
(UTC) Coordinated Universal Time
(UTC) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London
(UTC) Monrovia, Reykjavik
(UTC) Casablanca
(UTC+01:00) Amsterdam, Berlin, Bern, Rome, Stockholm, Vienna
(UTC+01:00) Belgrade, Bratislava, Budapest, Ljubljana, Prague
(UTC+01:00) Brussels, Copenhagen, Madrid, Paris
(UTC+01:00) Sarajevo, Skopje, Warsaw, Zagreb
(UTC+01:00) West Central Africa
(UTC+02:00) Athens, Bucharest, Istanbul
(UTC+02:00) Beirut
(UTC+02:00) Cairo
(UTC+02:00) Minsk
(UTC+02:00) Harare, Pretoria
(UTC+02:00) Helsinki, Kyiv, Riga, Sofia, Tallinn, Vilnius
(UTC+02:00) Jerusalem
(UTC+02:00) Windhoek
(UTC+03:00) Amman
(UTC+03:00) Baghdad
(UTC+03:00) Kuwait, Riyadh
(UTC+03:00) Moscow, St. Petersburg, Volgograd
(UTC+03:00) Nairobi
(UTC+03:30) Tehran
(UTC+04:00) Abu Dhabi, Muscat
(UTC+04:00) Baku
(UTC+04:00) Port Louis
(UTC+04:00) Tbilisi
(UTC+04:00) Yerevan
(UTC+04:30) Kabul
(UTC+05:00) Tashkent
(UTC+05:00) Ekaterinburg
(UTC+05:00) Islamabad, Karachi
(UTC+05:30) Chennai, Kolkata, Mumbai, New Delhi
(UTC+05:30) Sri Jayawardenepura
(UTC+05:45) Kathmandu
(UTC+06:00) Astana
(UTC+06:00) Dhaka
(UTC+06:30) Yangon (Rangoon)
(UTC+07:00) Bangkok, Hanoi, Jakarta
(UTC+07:00) Krasnoyarsk
(UTC+07:00) Novosibirsk
(UTC+08:00) Beijing, Chongqing, Hong Kong S.A.R., Urumqi
(UTC+08:00) Irkutsk
(UTC+08:00) Kuala Lumpur, Singapore
(UTC+08:00) Perth
(UTC+08:00) Taipei
(UTC+08:00) Ulaanbaatar
(UTC+09:00) Osaka, Sapporo, Tokyo
(UTC+09:00) Seoul
(UTC+09:00) Yakutsk
(UTC+09:30) Adelaide
(UTC+09:30) Darwin
(UTC+10:00) Brisbane
(UTC+10:00) Canberra, Melbourne, Sydney
(UTC+10:00) Guam, Port Moresby
(UTC+10:00) Hobart
(UTC+10:00) Vladivostok
(UTC+11:00) Magadan, Solomon Is., New Caledonia
(UTC+12:00) Auckland, Wellington
(UTC+12:00) Coordinated Universal Time+12
(UTC+12:00) Fiji Is., Marshall Is.
(UTC+12:00) Petropavlovsk-Kamchatsky
(UTC+13:00) Nuku'alofa
(UTC+13:00) Midway Island, Samoa
Car Seat Request Form
Families with limited income or whose children participate in a Medical Assistance program may be eligible for a free car seat.
Which of the following medical insurance plans do you currently have?
*
Please select a value...
Medical Assistance (or MA as a secondary coverage)
Private Insurance
No Insurance
Do you have Blue Advantage (Blue Plus) Medical Assistance?
*
Please select a value...
Yes
No
Great news!
Everyday Miracles distrubutes car seats for Blue Advantage (Blue Plus).
Please complete their
online form
to request a car seat.
Do you have HealthPartners Medical Assistance?
*
Please select a value...
Yes
No
Great news!
Everyday Miracles distrubutes car seats for HealthPartners.
Please complete their
online form
to request a car seat.
Do you have Ucare Medical Assistance?
*
Please select a value...
Yes
No
Great news
! UCare has a car seat benefit program and we distribute seats for eligible UCare members.
Please answer the following questions:
Do you have United Health Care Medical Assistance?
*
Please select a value...
Yes
No
Great news!
United Health Care has a seat benefit.
Please sign in to your
United Health Care
account or contact United Health Care Member Services at 1-800-493-4647.
Do you have straight Medical Assistance?
*
Please select a value...
Yes
No
Great news!
Washington County has a limited supply of car seats intended for families considered to be low-income.
Please answer the following questions:
Please contact a Public Health Nurse to better assist you with your car seat request.
Washington County Public Health & Environment |651-430-6655 |
PHE@co.washington.mn.us
Are you currently receiving financial assistance such as WIC, SNAP, or MFIP?
*
Please select a value...
Yes
No
Great news!
Washington County has a limited supply of car seats intended for families considered to be low-income.
Please answer the following questions:
Can you afford a car seat?
*
Please select a value...
Yes
No
Washington County has a limited supply of car seats intended for families considered to be low-income. If you have any questions, please contact Washington County Public Health & Environment at 651-430-6655.
Thank you.
Great news!
Washington County has a limited supply of car seats intended for families considered to be low-income.
Please answer the following questions:
First Name
*
Last Name
*
Phone Number
*
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Last Name
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Is this car seat for an unborn baby?
*
Please select a value...
Yes
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When is the baby's due date?
*
Do you have any other children that need a car seat?
Please select a value...
Yes
No
Child's Name
Date of Birth
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Date of Birth
Add another child