Polo Pony / Horse Surrender Form

Section 1

Horse Identification

Begin with the horse’s basic identity, registration, and intake records.

Horse’s Registered Name *

Stable / Nickname *

Foaling Date

Sex *

Mare Gelding Colt

Horse’s Sire

Horse’s Dam

Tattoo Number

Microchip Number

Registered Color

Current Coggins Date *

Markings

Copy of Coggins

Upload fields are available for review copies while live delivery is being connected.

Original Registration Papers

Original registration papers should accompany the horse.

Section 2

Soundness, History, and Behavior

Share any history that would help the club understand the horse’s current condition, handling, and suitability.

Section 3

Feed, Medical, and Care History

Include current feed, veterinary history, and the most recent routine care.

Grain Type

Grain Amount

Hay Type

Hay Amount

Other Supplements / Feed

History of colic or prior colic surgery? *

Yes No

Date of Colic Surgery

Current Veterinarian

Veterinarian Phone Number

Will X-rays, scans, or medical records accompany the horse? *

Yes No

Flu/Rhino Vaccination Date

Botulism Vaccination Date

Rabies Vaccination Date

West Nile Vaccination Date

EWT Vaccination Date

Other Vaccination / Date

Last Dental Float Date

Last De-worming Date

Type of Dewormer

Last Shoeing Date

Farrier History

Type of Shoes

Section 4

Horse Connections and Contact

Include the people currently connected to the horse so follow-up can be handled clearly.

Trainer Name

Trainer Phone

Trainer Email

Owner Name *

Owner Phone *

Owner Email *

Owner Mailing Address *

Section 5

Ownership Release

Please review the acknowledgments below. They preserve the meaning of the original surrender release while presenting it more clearly for web intake.

Required Acknowledgments *

I confirm that I am the sole legal owner of the horse, or I am acting as the authorized agent of the legal owner. I understand that custody and ownership of the horse are being released to Yellowstone Polo Club upon accepted intake. I authorize Yellowstone Polo Club to obtain relevant veterinary records, diagnostics, and medical history as needed for intake review and care. I understand that once intake is accepted and the required donation is received, prior owner responsibility ends. I understand that facility decisions regarding welfare, treatment, placement, and quality of life are final.

Owner Printed Name *

Owner Signature (Typed Full Legal Name) *

Date Signed *

Section 6

Acting Agent / Aftercare Program

Complete this section only if the horse is being coordinated through an aftercare program or acting agent.

Aftercare / Organization Registered Name

Track Based Out Of

Organization Director Contact

Phone Number

Email Address

Non-Profit EIN Number

Track Address

Mailing Address

Section 7

Donation and Intake Requirements

This section keeps the donation and arrival requirements clear before intake is finalized.

Donation Fee Amount *

Donation Method *

Personal Check PayPal Bank Transfer Other

Required Acknowledgments *

Current owners are responsible for shipping and transport costs. The donation must be received before arrival. Intake documents must accompany the horse.

Section 8

Intake Checklist

Please review the checklist below before submitting or shipping documents.

Horse’s donation fee
Current coggins
Vaccination records
Original registration papers
Jockey Club transfer
Any medical records
PDF scan acceptable for faster processing
Originals should still be mailed if required

A complete intake designed for clarity, care, and direct follow-up.