Pet Pantry Request Form

Please fill out the below form and someone will get back to you. (Your birth year is requested for possible grant opportunities.) Pet Pantry requests are only available for pick-up at Lollypop Farm. We are not able to make deliveries or shipments. If you are unable to pick up and are a city of Rochester resident, please contact Rochester Animal Services at 585-428-6738. Please note: For requests submitted on weekdays, someone will get back to you within 24 hours. Requests submitted after 3 p.m. on Fridays and on Saturdays and Sundays will be reviewed the following Monday. *Please note, that specific food brand or bag size requests may not be fulfilled as the pet pantry is filled by donations from the community.*

Contact Information

First Name *

Last Name *

Email Address *

Address 1

Address 2

City

State

Zip Code *

Phone *

Cell Phone

Notifications

Yes, I would like to receive e-mail from Lollypop Farm

Yes, I would like to receive postal mail from Lollypop Farm

Type of Pet (Dog, Cat, etc...) *

For a dog, large or small:

How many pets? *

Does your pet have allergies or any special needs? *

If your pet has an allergy/special need, please describe:

Requested date of pickup—please enter in XX/XX/XX format: