HPD-018 (Rev. 08-17) Pg. 1 of 1
All requests for public appearance, station tours or other community requests require no less than 2 weeksnotice. Once the request is received, it will be
processed and a member of the Hilliard Division of Police will contact you. By requesting a public appearance with the Hilliard Division of Police, you
agree to allow publication of photos taken during the appearance of all participants unless you notify us in writing at the time of your request.
Organization:
Contact Person:
Today’s Date:
Primary Phone:
Secondary Phone:
Email Address:
Address of Appearance:
City:
Zip:
Type of Appearance:
Bicycle Officer Block Watch Meeting Station Tour
Neighborhood Picnic/Parade Preschool Safety Talk Motorcycle Officer
Patrol Officer Specific Topic Speaker Other:
Reason for the Appearance (Please Be as Detailed as Possible):
Date of Appearance:
Beginning Time of the Appearance:
Ending Time of the Appearance:
Number of People Expected:
Age of Participants:
Signature of Person Submitting Request:
For Administrative Use Only
Approved Uniform for Event:
Class A Class B Dress Uniform
Bike Uniform K9 Uniform Plain Clothes
Bureau Lieutenant Signature:
Approved Denied
Assigned to:
Today’s Date:
HPD Member assigned to this public appearance must make contact with the requester as soon as possible but no later than 72 hours after being
assigned this detail.
HPD Member Confirming this Request:
Total Minutes on Assignment:
Total # Attending:
NOTES:
Routing: Public Relations Specialist - Bureau Lieutenant - Employee - Bureau Lieutenant - Public Relations Specialist
Hilliard Division of Police
CLEAR FORM
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