1. education
2. school

St. Simon’s Vacation Bible School 2015
Teen Leader Application Form
Do you enjoy working with children between the ages of 5 and 11? Are you a very punctual,
responsible, energetic, and spiritual person? If so, you are invited to volunteer your time, energy and
talents as camp leader for St. Simon’s Vacation Bible School this summer. The program will be held at
St. Simon Parish Center from June 22nd-26th, and will include students entering kindergarten through
sixth grade. The schedule for the teen camp volunteers will be from 8:30 AM - 12:30 PM on Monday Thursday, and 8:30 AM – 3:00 PM on Friday.
During camp, Teen Leaders will either act as crew leaders to a group of about 10 campers composed of
boys and girls in a specific age group or be given a different leadership role. The campers will be
divided into crews and about two teen leaders will be assigned to each crew.
All high school students and incoming 7th and 8th grade students have an opportunity to earn service
hours upon successful completion of the camp leadership training and VBS Camp. All crew leaders
will be expected to fully participate in all aspects of the camp’s daily activities.
Please note that, if selected, you will be required to attend TWO events prior to the week of camp.
Any conflicts with training or camp hours MUST be pre-approved by the Teen directors BEFORE the
program begins. Note that requested absences may affect where you are placed in the program. The
events are: Teen Leader training on Monday, June 1st and Tuesday, June 2nd from 7:00 PM–9:00
PM in the Simon Room. Additional service opportunities will be available on Saturday, June 20th
(from 9:00 am-1:00 pm) and various times working on the Skits, Music, or Decoration Teams.
Remember that your participation at the camp is a privilege. The campers’ experience is directly
related to the enthusiasm they see in the Teen Leaders. This opportunity will provide you with valuable
leadership training and experience throughout the week. You will be expected to joyfully welcome the
campers each morning, fulfill your responsibilities, listen to directions, and follow through with any of
your assigned tasks. If you are interested in making a commitment to this rewarding volunteer
opportunity, please fill out the form on the reverse side and mail it to:
St. Simon’s VBS Teen Leader Application
Attn: Moira Delumpa
1860 Grant Rd
Los Altos, CA 94024-6843
This application form, together with your essay and adult recommendation must be
received/postmarked by Tuesday, May 5th, 2015. Late applications will not be accepted.
For more information or any questions please email [email protected] or call Moira at (408) 439-4315.
VBS 2015 Teen Leader Application Form – pgs. 2 of 3
Student Information:
Student’s Name: ____________________________________________________________
Address: ___________________________________________________________________
Phone Number: ____________________ E-mail Address: ___________________________
Grade entering in Fall 2015:
_________ T-shirt size (Adult - S, M, L): ______________
(This needs to be an appropriately sized shirt)
Were you a teen leader last year? ______
If so, what was your position? _______________
Please circle your areas of interest: (we will do our best to match your interests and the needs of VBS)
Table counselor for Kinder, Grade 1, Grade 2, Grade 3, Grade 4, Grade 5/6, or be a Station Counselor for
sports/games, snacks, theme center, crafts, or be a floater
Participating in: skits, music, sports/games, snacks, money, theme center, crafts and, decoration.
Emergency Contacts & Information:
Name: ____________________ Relationship: _____________ Phone: ________________
Name: ____________________ Relationship: _____________ Phone: ________________
Doctor’s Name: ______________________________________ Phone: ________________
Dentist’s Name: ______________________________________ Phone: _______________
Insurance Carrier: __________________________
Policy Number: __________________
Allergies or Medical Information: PLEASE ATTACH SHEET WITH ALL PERTINENT INFORMATION
Preferred Hospital: _______________________________________________________
Parent Information:
Parent’s Name: _________________________________________________________
Address: ______________________________________________________________
Phone Number:(Day) ____________________ (Evening) _______________________
Email: _______________________________________________
I hereby grant permission for the student named above to participate as a volunteer in St. Simon’s Vacation
Bible School 2015, held June 22nd-26th, from 8:30 AM- 12:30 PM on Monday-Thursday, and 8:30 AM-3:00
PM on Friday of the camp week.
If required, I grant permission for any medical, surgical, or first aid attention to be provided in the event of an
accident or illness. I will also ensure that my teen is available for trainings on Monday, June 1st from 7:00 PM to
9:00 PM and Tuesday, June 2nd from 7:00 PM to 9:00 PM, and for a 2-hours shift on Saturday, June 20th or some
other designated time.
Additionally, I grant permission for the VBS Directors/Teen Coordinators to contact my teen and I through
email for any updates on camp-related events, trainings, schedule changes, reminders, etc. at the email addresses
given on this application form.
________________________________________
Signature of Parent/Guardian
_____________
Date
VBS 2015 Teen Leader Application Form – pgs. 3 of 3
Teen Leader Applicant:
Please write a short essay (limit one page) describing why you think we should pick you as a Teen Leader and
describe what skills/talents/experience you have that will make you an excellent VBS counselor. Please use
reverse side or attach a page to the application form for your one-page essay.
Be sure to return all pages, including the Adult Recommendation, by the Tuesday, May 5th, 2015 deadline.
Late applications will not be accepted. You may submit your essay and adult recommendation via email to
[email protected]. Please note that we read your Application essay and Adult Recommendation
carefully before making our decision.
Adult Recommendation:
(From an Employer/Parish Staff/Teacher/Neighbor – not a Relative)
___________________________ is applying for a Teen Leader Volunteer position at
St Simon Vacation Bible School 2015 for which s/he will earn service hours and be in a position to lead and
inspire young children. We appreciate you briefly sharing with us how long you have known this teen and why
you think this teen would be a good role model for young campers.
I, ___________________________, recommend ____________________________ for the position of Teen
Leader for St. Simon Vacation Bible School 2015. I have known the teen for _____ years and I know s/he
__________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please be honest about what situations this student may or may not work well.
Signature: ______________________________ Relationship to applicant: _______________