Report an Unbuckled Child

Submit your report within 10 days of observation. The owners of the vehicle will receive an informational letter asking them to obey Virginia's traffic and life saving child passenger safety laws.

Thank You for Helping Save Lives!

License Plate Number
License Plate State
Vehicle Color
Vehicle Style
Date and Time of Observation: (MM/DD/YYYY) (HH:MM) AM PM
Location of Moving Vehicle - Street & City:


Number of Unsecured Children:

Front Seat Back Seat Other

Approximate Age(s) of Unbuckled Child(ren):
Infant 1 Year - 2 Years 3 Years - 4 Years
4 Years - 8 Years 8 Years - 12 Years 13 Years - 16 Years
Children Sighted:
Sitting on Passenger's Lap Pickup Truck Bed
Standing in Vehicle Moving Around in Vehicle
Sitting on Driver's Lap Sitting, but not Secured
  Other (Please Comment below)
Additional Observations:



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