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Outreach Team For The Elderly (老友記外展大使隊) Registration form for Outreach Ambassador
Objectives:
(1) To raise the awareness on disease prevention and healthy living among the elders
(2) To identify elders with potential health and living problems
(3) To promote the concept of respect and care for the elders, and inter-generational harmony
(4) To strengthen the supportive network in the neighborhood
(5) To provide care to the elders and to show them warmth and appreciation from the society


Role of Outreach Ambassadors:
(1) Offer care and love to the elders
(2) Disseminate health information to the elders
(3 )Observe home condition and self-care ability of the elders

Number of home visits:
During 2017-2018, a maximum of 26 home visits will be arranged on Saturday afternoons. Each group (mixed with doctors, medical students, secondary school students, elderly & residents in Chai Wan) will visit 2-3 households and each household visit lasts about 1 hour. Special arrangements can be made for volunteers who can only join the visits on weekdays. Ideally each team should engage about 18 home visits over these two years but alternative arrangements such as flexible team members and/or different number of visits can be made.

I / We would like to join the home visits on Saturday afternoons.
I / We would like to join the home visits on weekdays. (Please indicate your preferred timeslots below)
(Each applicant can bring 2 additional applications to join the programme) Name of Principal Applicant
Your answer
HKMA No. (If applicable)
Your answer
Mobile No.
Your answer
Email Address
Your answer
Fax No.
Your answer
Gender
Name of family members/ friends of principal applicant
Your answer
HKMA No (If applicable)
Your answer
Gender
Age
If family members/ friends are under age of 10, please indicate the exact age
Your answer
Relationship with principal applicant
Your answer
Name of family members/ friends of principal applicant
Your answer
HKMA No (if applicable)
Your answer
Gender
Age
If family members/ friends are under age of 10, please indicate the exact age
Your answer
Relationship with principal applicant
Your answer
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