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MY LIFE SKILLS Sex Education Activity Registration Form

MY PLACE | LGBTQ+ Friendly Clinic
MY LIFE SKILLS Sex Education Activity Registration Form

MY LIFE SKILLS Sex Education Activity Registration Form

This form is used to record the application for MY LIFE SKILLS sex education activities.
After receiving the form, colleagues will contact the applicant to confirm the registration arrangements for related sex education activities.

If your organization is interested in cooperating to design a more comprehensive service model or is interested in knowing more details, please call 2394 6677 (Ext 707)
Or email to youth@aidsconcern.org.hk to contact the “AIDS Care” youth team colleagues.

MY LIFE SKILLS Registration Form

青少年正面性教育活動 / Youth positive sex education activities – Step 1 of 2

申請人姓名 Applicant's name *

申請人職銜 Applicant's title *

申請單位 (機構/團體/學校) Application Unit (Agency / Group / School) *

地址 Address *

聯絡方法 Contact method *

電郵地址 Email address *

你的性教育活動 / 培訓對象是 Your sex education activities/training target is *

青少年 Youth
專業同工 Co-worker
家長 Parent
團體探訪/機構參觀 Agency Visit

青少年正面性教育活動 / Youth positive sex education activities

本團體/機構有意申請青少年正面性教育活動： Our group/organization intends to apply for positive youth education activities:

Date / Time *

Date

Time

活動模式 Activity mode *

講座 Lecture
工作坊 Workshop
小組 Group activities
學校攤位遊戲 School Booth

參與活動人數 Number of participants *

收費會根據學生人數而有所調整，詳情請參考 MY LIFE SKILLS 網站 / Fees will be adjusted according to the number of students, please refer to MY LIFE SKILLS website for details

對象 Target ordinance *

只限男生 Male only
只限女生 Female only
不限性別 Any gender

請選擇性教育主題 Please select the educational topic *

主題 1: 青春期及身體結構 / Body Structure & Puberty
主題 2: 性病及愛滋病 / HIV & STIs
主題 3: 安全性行為 / Safer Sex Practice
主題 4: 親密界線 / Intimacy Boundaries
主題 5: 戀愛關係 / Love Relationship
主題 6: 性文化及網絡交友 / Sex Culture and Cyber-Dating
主題 7: 認識性傾向 / LBGTQ+

活動主題內容請參考 MY LIFE SKILLS 網站 / Please refer to the MY LIFE SKILLS website for the content of the event

備註 Remark

如有特別需要, 請註明。也可以讓我們知道服務對象的需要。If you have special needs, please specify. It can also let us know the needs of our target ordinance.

專業人士性教育訓練 – 如何向青少年進行性教育預防教育及支援青少年性健康發展 / Professional sex education training-how to conduct sex education preventive education for young people and support the healthy development of young people's sex

本團體/機構有意申請專業人士性教育訓練 / Our group / organization intends to apply for professional sex education and training:

活動模式 Activity mode *

講座 Lecture
工作坊 Workshop
小組 Group activities

參與活動人數 Number of participants *

請選擇性教育主題 / Please select the topic

第一節: 認識基本性健康知識及性健康危機處理 / Understand basic sexual health knowledge and how to deal with sexual health crises
第二節: 認識正面性教育理念及與青少年談性的技巧 / Understand the concept of positive sex education and the skills to talk to young people about sex
第三節: 認識性小眾青少年 / explanation about sexual minorities

同工可以按需要選擇不同組合的課程，內容請參考 MY LIFE SKILLS 網站 / Co-workers can choose different combinations of courses according to their needs, please refer to the MY LIFE SKILLS website for details

備註 Remark

如有特別需要, 請註明。也可以讓我們知道服務對象的需要。If you have special needs, please specify. It can also let us know the needs of our target ordinance.

家長性教育 – 如何與子女談性 / Parental sex education-how to talk about sex with children

本團體/機構有意申請家長性教育活動：Our group/organization intends to apply for parental sex education activities:

活動模式 Activity mode *

講座 Lecture
工作坊 Workshop
小組 Group activities

參與活動人數 Number of participants *

備註 Remark

如有特別需要, 請註明。也可以讓我們知道服務對象的需要。If you have special needs, please specify. It can also let us know the needs of our target ordinance.

團體探訪 Group visit / 機構參觀 Agency visit:

本團體 / 機構有意申請團體探訪 / 機構參觀。Our group/organization is interested in applying for group visit/Agency visit

活動模式 Activity mode *

講座 Lecture
工作坊 Workshop
小組 Group activities

參與活動人數 Number of participants *

備註 Remark

如有特別需要, 請註明。也可以讓我們知道服務對象的需要。If you have special needs, please specify. It can also let us know the needs of our target ordinance.

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姓名 Name *

電話 Phone *

性別 Gender *

男 Male
女 Female
其他 Other

電郵 Email *

預約日期 Preferred Date *//

你從何得知MY PLACE的資訊？How did you know about MY PLACE? *

「關懷愛滋」網站 AIDS Concern's Website
社交平台 Social Media Sites
訂房app廣告 Ads on Room Booking Apps
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他 Others

姓名 Name *

電話 Phone *

性別 Sex *

男 Male
女 Female
其他（可於備註註明）Other（Please specify in Remarks）

電郵 Email *

預約日期 Preferred Date *//

尿道炎測試 Urethritis Test

口腔拭子測試 Oral Swab Test
生殖器拭子測試 Genital Swab Test
肛門拭子測試 Anal Swab Test

HPV 33型 DNA檢測 HPV 33 Geno type DNA Test

口腔拭子測試 Oral Swab Test
生殖器拭子測試 Genital Swab Test
肛門拭子測試 Anal Swab Test

HSV 1&2 檢測 HSV 1&2 Test

口腔拭子測試 Oral Swab Test
生殖器拭子測試 Genital Swab Test
肛門拭子測試 Anal Swab Test

請問您從何得知MY PLACE的資訊？ How did you know about MY PLACE? *

關懷愛滋網站 AIDS Concern‘s Website
社交平台 Social Media Sites
搜尋引擎 (如 Google ,Yahoo!) Search Engines (eg Google ,Yahoo!)
他人介紹 Referred by Others
其他（可於備註註明）Other（Please specify in Remarks）

備註 Remarks

姓名 Name *

電話 Phone *

性別 Sex *

男 Male
女 Female
其他 Others

電郵 Email *

擬體檢日期 Preferred Date (星期日休息 Closed on Sundays) *//

你從何得知MY PLACE的資訊？How did you know about MY PLACE? *

「關懷愛滋」網站 AIDS Concern's Website
社交平台 Social Media Sites
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他(可於備註註明) Others (please specify in Remarks)

備註 Remarks

姓名 Name *

電話 Phone *

性別 Sex *

男 Male
女 Female
其他 Others

電郵 Email *

擬預約日期 Preferred Date (星期日休息 Closed on Sundays) *//

希望預約的體檢計劃 Checkup Package Preferred *

體檢套餐 Checkup (Plan A)
體檢套餐 Checkup (Plan B)
體檢套餐 Checkup (Plan C)
體檢套餐 Checkup (Plan D)
自選套餐 "Just Check" Plan
獨立化驗項目 Individual Test

你從何得知MY PLACE的資訊？How did you know about MY PLACE? *

「關懷愛滋」網站 AIDS Concern's Website
社交平台 Social Media Sites
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他(可於備註註明) Others (please specify in Remarks)

備註 Remarks

姓名 Name *

電話 Phone *

使用者 Client *

現有使用者 I'm on PrEP
新使用者 I'm not currently on PrEP

電郵 Email *

預約日期 Preferred Date 逢星期日休息 (Closed on Sundays) *//

你從何得知MY PLACE的資訊？How did you know about MY PLACE? *

「關懷愛滋」網站 AIDS Concern’s Website
社交平台 Social Media Sites
訂房app廣告 Ads on Room Booking Apps
搜尋引擎(如Google,Yahoo) Search Engines (eg Google, Yahoo)
他人介紹 Referred by Others
其他(可於備註註明) Others (please specify in Remarks)

備註 Remark