Public Liability Form Public Liability Form Name* Contact NumberActivity/Event Name Church/Organization Name Activity Location Activity DescriptionEmail address to send the PLC to Date Activity Commences DD slash MM slash YYYY Date Activity Ends DD slash MM slash YYYY SDA Group organising or involved in this activity: Has your local Conference ADRA Director approved the activity? Yes No Who is the non SDA organisation requesting this certificate? e.g. local council name or Foodbank* Non SDA organisation Street Address* Non SDA organisation Suburb* Non SDA organisation State* Non SDA organisation Postcode* Date PLC is required by DD slash MM slash YYYY