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Leadership Academy 2024 – For Ages 16 to 17, or Completed 10th Grade

Remember: Campers who sign up before December 1, 2023, receive a 10% discount on their camp fee. Click on Dates & Rates under Families on the menu bar for details.

Application Leadership Academy 2024

Fill out the online application below. Payment instructions can be found below. You may complete this form in one sitting or choose “Save and Continue Later” if you need to step away and return.

Session Dates & Rates*
- FIRST TERM Sunday, June 23 to Saturday, July 13, Total Camp Fee (inclu. tax) $4,275.00
- SECOND TERM Sunday, July 14 to Saturday, August 3, Total Camp Fee (inclu. tax) $4,275.00
Camper’s Last Name*
Last Name
Camper’s First and Middle Name(s)*
First Name Middle Name
Camper’s Nickname (if applicable)
Nickname
DOB*
Age on June 1, 2024*
School Attending*
Grade for 2023-24*
Height*
Weight*
Mailing Address*
Street Address or PO Box City State / Province / Region ZIP / Postal Code Country
Home Phone (if applicable)
Camper’s T-Shirt Size*
Parent / Guardian #1 Name*
Parent / Guardian #2 Name
Parent / Guardian #1 Cell Number*
Parent / Guardian #2 Cell Number
Parent / Guardian #1 Email*
Parent / Guardian #2 Email
Camper resides with*
- Parents
- Mother
- Father
- Other
(please explain)
How did you find out about Camp Greenbrier?*
Has your son spent the night away from home? If so, please specify with whom.*
Does he have brothers? Ages?*
Does he have sisters? Ages?*
Does he have any anxiety about going to camp? Please explain.*
Does he have a large circle of friends?*
Does he need help in making friends?*
Does he have any learning difficulties? Please specify.*
Does he have any behavioral challenges? Please specify.*
What in particular do you wish for him to gain from his summer at Greenbrier?
Additional Comments (please list any suggestions that will be helpful to our staff in providing your son a happy, worthwhile camping experience):
Terms of Agreement
Terms:
1. To Apply: To apply, complete this Application, and return it with a $300.00 deposit. The balance of the camp fee is due by May 15, 2024.
2. Fee: The fee for First Term or Second Term is $4,275.00. The fee for Full Season is $7,400.00. Payment in full is due by May 15, 2024. Payment is by check, Visa, MasterCard, or American Express. Checks should be made out to Camp Greenbrier. Brothers who sign up each receive a 5% discount. Campers who sign up by December 1, 2023, receive a 10% discount with three equal payments to be made by January 15, March 15, and May 15, 2024. Payment details can be found below.
3. Travel: Campers should arrive between 10:00 a.m. and 4:00 p.m. on the day their session starts. Campers can be brought to camp by car, fly into Greenbrier Valley Airport, or fly into Dulles International Airport, outside of Washington, DC. Amtrak may also provide transportation to Alderson, WV. The train station is two miles from camp (check for age minimums for passengers). There is a $135.00 fee for the Dulles pick-up and transportation to camp, and there is a $100.00 fee for transportation to Dulles for flights home from camp. Remember, campers traveling to camp through Dulles International Airport should arrive at Dulles on the day before their session starts. And for travel home via Dulles, campers’ flights should depart after 3:30 p.m. on the last day of the camper’s session allowing us time to get them to the airport and through security. Campers can travel home by car, fly out of Greenbrier Valley Airport, or fly out of Dulles International Airport. For travel home by car, campers should be picked up between 9:00 a.m. and noon on the last day of the session. Those flying home from Greenbrier Valley Airport can depart any time after 10:00 a.m.
4. Withdrawal: For withdrawals before May 1, 2024, all fees shall be refunded except for credit card fees previously incurred by the camp. For withdrawals between May 1 and May 15, 2024, the $300.00 deposit and any credit card fees previously incurred by the camp are forfeited, with all other fees to be refunded. For withdrawals after May 15, 2024, all fees are forfeited except in the case of injury or illness that prevents camp attendance. In the case of injury or illness, any credit card fees previously incurred by the camp shall be forfeited, with all other fees refunded. Written proof of the injury or illness from a physician is required.
5. Late Arrival or Early Departure: No refund is made for late arrival. No refund is made for early departure unless due to injury or illness. If early departure is due to injury or illness, the refund shall be prorated based on the time completed.
6. Dismissal: Camp Greenbrier reserves the right to dismiss, without refund, any camper whose behavior is deemed by the Camp Director to be inappropriate in the camp community.
7. Activity Risks: Camp Greenbrier operates with the highest safety standards. It does not, however, assume liability for sickness, disease, or accidents. By signing this Application, each parent/guardian acknowledges that there is inherent risk in participating in a camp program. Each parent/guardian further acknowledges that he/she is fully aware of the nature of these risks at the time of the signing of this Application, and that he/she has been given ample opportunity to ask any questions about the risks involved in the camp’s program and activities. For a few of the activities, there may be additional signed agreements required by the subcontractors who run them. These agreements will be forwarded in late spring / early summer.
8. Rules: Each camper agrees to abide by the rules and regulations of the camp, and to obey the staff and counselors who run the camp. The parent/guardian hereby agrees to release Camp Greenbrier, its officers, directors, staff, and counselors from any liability for any injury to a camper that results due to the camper’s failure to follow the rules and regulations of the camp, or due to the camper’s failure to obey the staff and the counselors.
9. Health Care: By signing this Application, the parent/guardian hereby gives permission to the physician or health care provider selected by the Camp Director to order x-rays, routine tests, and any other medical treatment necessary for the health of the camper, and the parent/guardian further agrees to pay all medical expenses for the camper while he is at camp. The parent/guardian further permits the staff of the camp to provide first aid to the camper, as the staff deems necessary for the well-being of the camper.
10. Health Form: The parent/guardian agrees to fully complete the Health Form supplied by the camp, and to return it to the camp by May 15, 2024. The parent/guardian further agrees that he/she has fully disclosed on the health form any physical or mental issues or disabilities of the camper.
11. Photos, Videos, or Audio: Camp Greenbrier reserves the right to use photographs, videos, or audio of the campers for promotional purposes.
12. Applicable Laws: Any disputes arising out of the signing of this Application, or out of a camper’s attendance at camp, shall be deemed to have occurred in West Virginia, and shall be settled in accordance with West Virginia laws, and in West Virginia courts, if necessary.
Terms of Agreement: I, the undersigned parent / guardian, acknowledge that I am fully aware of the activities that my son will take part in while at Camp. I further agree that I have carefully read the Terms of Agreement above, and that I fully accept all of these terms.
By typing your signature below, you are providing your legal signature.
Signature of Parent / Guardian*
Date*
MM slash DD slash YYYY
Payment Instructions
Payment can be made by paper check through the regular mail (our strongly preferred method), online through your bank account, or via credit card. For online bank account payments, you can search for your bank and sign into your account to make a payment. All online payments go through our secure Stripe payment gateway.
Payment Option*
- Paper Check (choose this method if you will send a check separately through the regular mail to Camp Greenbrier, PO Box 585, Exmore, VA 23350)
- US Bank Account Online – Bank Search (choose this method to search for and sign into your bank account)
- Credit Card
Leadership Academy Payment Amount
Please enter in the box below the amount you are sending today (minimum $300.00 deposit is required; full payment can be made as well).
Leadership Academy Payment Amount
Please enter the amount you wish to pay today (minimum $300.00 deposit is required; full payment can be made as well).
Total
$0.00
Payment Method
Just below, choose “Card” to make a credit card payment, or “US bank account” to search for and log in to your bank to make a payment. At this time the option to “Enter bank details manually instead” (found further down the page) is not available.
Payment Method
Billing Address
Check this box if same as Mailing Address above

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Signature of Payer*
Date*
MM slash DD slash YYYY
I Would Like to Recommend for Camp Greenbrier:
- Yes, I’d like to recommend a friend for Camp Greenbrier
Parents’ Names
Parents’ Email
Parents’ Phone
Mailing Address
Street Address City State / Province / Region ZIP / Postal Code Country
Boy’s Name
Age

Save and Continue Later

Leadership Academy 2024 – For Ages 16 to 17, or Completed 10th Grade

Application Leadership Academy 2024

Terms of Agreement

Payment Instructions

Payment Method

Winter Address:Sept. - May

Summer Address:June - August