AMDS-Application - Alongside

Advance Medical Directive Simulation Workshop by Alongside, providing immersive role-playing experiences for medical professionals and patients.

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Registration Form for Advance Medical Directive Simulation (AMDS)

預設醫療指示模擬工作坊（AMDS）報名登記表格
Registration Form for Advance Medical Directive Simulation (AMDS)

Thank you for your interest in joining the Advance Medical Directive Simulation (AMDS) Workshop!

Our next AMDS will be hosted on 24 May 2025.

To help us better understand your background and participation needs, and to ensure your safety during the experience, please complete the following form.

Important Notes:

This is an immersive simulation workshop. Some scenarios may evoke memories or emotional responses related to death, grief, or serious illness.
To safeguard your physical and emotional wellbeing, we ask for relevant health and psychological information.
Completion of this form does not guarantee a spot in the workshop.

If you have any questions, feel free to contact us via WhatsApp at 9777 8046 or email at info@walkalongside.org.

Items marked with () are required fields.*

(1) Personal Information

Full Name

Preferred Name / What should we call you?

Phone Number

Email Address

Age Group

18-29

30-39

40-59

60 or above

Gender

Female

Male

Non-binary

Other, please specify:

Please Specify：

Sexual Orientation

Heterosexual

Lesbian / Gay

Bisexual

Pansexual

Asexual

Other, please specify:

Please Specify：

Which session of the AMDS workshop would you like to join?

24 May (Saturday) Morning Session – 09:30 to 13:00

24 May (Saturday) Afternoon Session – 14:00 to 17:30

Do you require any accessibility or support tools to participate (e.g., wheelchair access, sign language interpretation)?

Yes, please specify:

Please Specify:

Occupation

Doctor

Nurse

Other healthcare profession, please specify:

Social worker (medical)

Social worker (non-medical)

Other, please specify:

Please Specify:

If you are a healthcare professional or medical social worker, what is your current department?

If you are willing, may we collect emergency contact information?

Yes

Name of Emergency Contact:

Phone Number of of Emergency Contact:

Relationship of of Emergency Contact:

(2) Participation Preferences

This activity includes role-play. Are you interested in taking part in role-playing?

Yes

Have you experienced the serious illness or death of a family member or close friend?

Yes

Not sure

If “Yes,” feel free to briefly share about the experience (optional):

For safety purposes, please select all that apply to you:

Currently pregnant

High blood pressure or other cardiovascular conditions

History of panic attacks or anxiety disorders

Epilepsy or other neurological conditions

History of Post-Traumatic Stress Disorder (PTSD)

Currently receiving psychiatric treatment, counselling, or taking psychiatric medications

None of the above

Why would you like to join the AMDS workshop? (Select all that apply)

Interested in role-play or immersive scenario activities

Interested in medical simulation

Wish to gain deeper understanding of Advance Medical Directives and end-of-life situations

Hoping to process past experiences related to death or serious illness

Other, please specify:

Do you consent to photographs or video recordings taken during the workshop (excluding any personal identifiers) being used for promotional or educational purposes?

Yes

Others

(3) Declaration

I understand that the Advance Medical Directive Simulation (AMDS) Workshop involves sensitive end-of-life topics and uses highly realistic simulation settings and tools that may evoke strong emotional responses. I confirm that I have considered my emotional and physical readiness and am voluntarily applying to join this workshop.

I declare that I am at least 18 years old and that I agree to participate in the AMDS workshop with full awareness of its content and potential risks.

I have read and agreed to the terms and conditions in the Personal Information Collection Statement.

I am willing to receive the event promotion information and direct marketing from Alongside via the submitted personal information.

If you have any queries or concerns, feel free to contact us at any time.
We will notify you of your registration result within two weeks.

Questions?

We are eager to hear from you and provide any assistance you may need. We look forward to connecting with you soon!