Lollypop Farm Camp @ Home Scholarship Application
Please complete this form to request a scholarship for Lollypop Farm Camp @ Home.
Questions? Please email Camp@Lollypop.org
Camper's Full Name
Camper's Date of Birth
Camper's Grade (If applicable)
Parent/Guardian Full Name(s)
Number of people living in the household
Please briefly explain why you are requesting financial support for Lollypop Farm Camp @ Home.
Name & Date of the Camp Session that you are requesting financial assistance for
Additional Information (optional)
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Lollypop Farm, Humane Society of Rochester.