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HAWAI'I POLICE DEPARTMENT <br />349 KAPI'OLANI STREET <br />H I LO, HAWAII 96720 <br />PHONE FAX <br />AREA 1 (808) 961-8121 (808) 961-8845 <br />AREA 11 (808) 326-4646 ext 258 (808) 327-3653 <br />HI -PAL TEAM ELIGIBILITY ROSTER <br />CLUB: AGE GROUP: <br />PARTICIPANT BIRTHDATE GRADE UNIFORM # W BC T-SHIRT <br />SIZE <br />I CERTIFY THAT THE DATES OF BIRTH OF THE PARTICIPANTS LISTED ABOVE AND CORRECT AND HAVE <br />BEEN SUBSTANTIATED BY BIRTH CERTIFICATES EXAMINED BY ME; THAT THE ADDRESSES OF EACH <br />PARTICIPANT IS CORRECT AND EACH PARTICIPANT LIVES WITHIN THE BOUNDARIES. <br />SIGNATURE OF AUTHORIZED CLUB OFFICIAL I DATE I TIME I PHONE NO. <br />EMAIL <br />SIGNATURE OF HI -PAL DIRECTOR <br />HPD/HIPAL-009 REV 3-11-09 RETENTION <br />