City, State, Zip

Contact Information



Email (additional)

If you are having trouble receiving emails please check your spam folder or contact the office.


Box pricing includes one (1) VIP Parking Pass per box and all applicable sales tax.

Covered Box (seats six) = $4,470.72Uncovered Box (seats six) = $3,756.27

Box Information

Please write the name(s) below as you would like them to appear on your box sign. Maximum of two company names or up to three first and last names are acceptable.

Box #


Payment Amount Authorized $

The Houston Polo Club accepts payment by check or credit card. (Discover, MasterCard or Visa) If paying by check, please make payable to “Houston Polo Club” and mail to the address at the bottom of the form.

Credit Card Payment

Card Type>

Card Number

Expiration Date

Billing Zip Code


I hereby acknowledge that the use of the Club Facilities and any privilege or service incident is undertaken with knowledge of risk of possible injury. I hereby accept any and all risk of injury to myself, my guests sustained while using the Club Facilities or while involved in any event or activity incident at the Club. I hereby waive against Houston Polo Club, its affiliates, successors or assigns, and their respective partners, directors, officers, shareholders, employees, agents and representatives, and advisory members of the Board of Directors of the Club (collectively, the "Club Parties"), and shall indemnify, defend and hold the Club Parties harmless from and against, all losses, costs, expenses (including reasonable legal fees and expenses), claims, injuries, damages or liabilities of any kind or nature (collectively, "Damages") directly or indirectly arising out of, caused by, in connection with, related to, or resulting from (in whole or in part) any use of the Club Facilities by me or my spouse, children, guests, invitees, or anyone else on or using the Club Facilities at my invitation, or at the invitation of my spouse or any of my children, or, if I am an entity, my affiliates, and their respective partners, members, managers, directors, officers, shareholders, employees, agents and representatives. THE FOREGOING INDEMNITY OBLIGATION SHALL APPLY TO DAMAGES EVEN IF SUCH DAMAGES ARE CAUSED IN WHOLE OR IN PART BY THE SOLE, JOINT OR CONCURRENT ORDINARY NEGLIGENCE, FAULT OR STRICT LIABILITY OF ANY CLUB PARTY, WHETHER OR NOT SUCH SOLE OR CONCURRENT ORDINARY NEGLIGENCE, FAULT, OR STRICT IN THE CASE A MATCH IS STOPPED IN PLAY DUE TO WEATHER OR A MATCH IS CANCELLED DUE TO WEATHER, NO REFUNDS WILL BE GIVEN. WE DO OUR BEST TO OFFER WEEKDAY MATCHES TO MAKE UP FOR ANY POLO MATCHES THAT MAY BE CANCELLED DUE TO WEATHER. SCHEDULES AND WEATHER LIABILITY IS ACTIVE OR PASSIVE.

Box Holder Signature

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