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Lollypop Farm Camp Scholarship Application
Please complete this form to request a scholarship for Lollypop Farm Camp @ Home.
Questions? Please email Camp@Lollypop.orgĀ
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Email
*
Your email
Camper's Full Name
Your answer
Camper's Date of Birth
MM
/
DD
/
YYYY
Camper school
Your answer
Camper's Grade (If applicable)
Your answer
Home Address
Your answer
Phone Number
Your answer
Parent/Guardian Full Name(s)
Your answer
Number of people living in the household
Your answer
Please briefly explain why you are requesting financial support for Lollypop Farm Camp.
Your answer
Name & Date of the Camp Session that you are requesting financial assistance for
Your answer
Additional Information (optional)
Your answer
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, the Humane Society of Greater Rochester.
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