Equine Donation Form
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Jockey Club Name
*
Jockey Club Number
*
Tattoo or Microchip
*
Year Born
*
Sex
*
Mare
Mare - In Foal
Gelding
Has the ‘Responsible Party’ marked the equine ‘ineligible to race’ in the HISA portal?
*
YES
NO
List any known injuries, providing as much detail as possible (description, date of occurrence, treatments, DVM, etc).
*
Describe the equine’s temperament, habits, or personality traits which HART and its adopters should know.
*
List any known vices or quirks (Cribbing, Weaving, Stall Aggression, Problems with Saddling, etc).
*
Is there any additional information about the equine you’d like to share? (Medical History, Personality Traits, etc?)
*
Do you participate in the ‘Per Start’ Donation Program?
*
YES
NO
Tax Deductible Donation Amount
*
$500
$1000
$2000
Other
I give permission to release all veterinary records, ultrasounds, x-rays, and diagnostics to HART and its representatives.
*
As the licensed agent, owner, or ruling share owner, I hereby donate the above-named equine to Hope After Racing Thoroughbreds (HART) and thereby relinquish all Ownership of this animal. I understand that HART will not be held liable for any ownership disputes resulting from this donation. I understand that HART will not be responsible for any financial obligations incurred by the owners(s) on behalf of this equine prior to its donation to HART. Should HART find a suitable home: I understand that I am consenting to adoption. Of the equine by an individual or organization approved by HART. I understand and agree that I am transferring full ownership of my equine to HART and that HART has full authority for all necessary veterinary procedures including euthanasia if necessary. Further, to the best of my knowledge, I hereby certify that the information contained within this document is complete, wholly accurate and true.
*
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