Public Liability Form Public Liability Form Name*Contact NumberActivity/Event NameChurch/Organization NameActivity LocationActivity DescriptionEmail address to send the PLC to Date Activity Commences Date Format: DD slash MM slash YYYY Date Activity Ends Date Format: DD slash MM slash YYYY SDA Group organising or involved in this activity:Has your local Conference ADRA Director approved the activity?YesNoWho is the non SDA organisation requesting this certificate? e.g. local council name or FoodbankNon SDA organisation Street AddressNon SDA organisation SuburbNon SDA organisation StateNon SDA organisation PostcodeDate PLC is required by Date Format: DD slash MM slash YYYY