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
Email address *
Camper's Full Name
Camper's Date of Birth
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Camper school
Camper's Grade (If applicable)
Home Address
Phone Number
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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