Public Liability Form

"*" indicates required fields

Name*

Contact Number

Activity/Event Name

Church/Organisation Name

Activity Location

Activity Description

Email to send the PLC to

Date Activity Commences

Date Activity Ends

SDA Group organising/involved in this activity

Has your local Conference ADRA Director approved the activity?

Yes

What is the non SDA organisation requesting this certificate? e.g. local council name or Foodbank*

Non SDA Organisation Address*

Street Address Suburb State / Province / Region ZIP / Postal Code

Date PLC is required by

Donate