Burgundy Hollow
XC Fun Days and Clinic Entry Form
Event:
 Date.
Name.
Address.
Phone.
 Cell Phone.
Email Address.
Level for fun day or clinic:
 Starter.
 BN.
 N.
Have you ever competed?  
What level:
Starter.
 BN.
 N.
Emergency contact.
 Relationship to
Emergency contact.
Phone.
Preferred time of day:
 Early am.
 Late am/Early afternoon.
 Mid/late afternoon.
Please be sure to print and sign release.   Parent must sign for any rider
under age 18.   Make payment to Burgundy Hollow Farm, Inc.
                                               
                                            Burgundy Hollow Farm, Inc.
                                           610-417-4231
                                 burgundyhollow@yahoo.com

        Mailing Address:                                                   Farm Address for Driving Directions:
Burgundy Hollow Farm, Inc.                                     (DO NOT SEND MAIL TO THIS ADDRESS)
   c/o Michelle M. Casale                                                          Burgundy Hollow Farm, Inc.
         204 Bellis Court.                                                                      3368 Church Road
    Stroudsburg, PA 18360                                                               Northampton, PA 18067