Adopt A House/Crowdrise.com Fundraiser Registration Form

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Hi! We are excited to set up a crowdrise.com fundraiser on your behalf. In order for you to remain anonymous AND for us to be able to determine who you are, we need to set up the page on your behalf. You are encouraged to join as a "team member" and share the page with your network of friends and family.

First name *

last name *

email address *

Please double, and triple check that your email address is correct in this field!

Street Address *

City *

zip *

Amount of money you wish to raise. *

Please briefly describe what you are raising money for. *

Create a short narrative about your loss and what the money will be used for.

Is your mailing address different? ONLY IF YES, please enter it below. *

street, city, state, zip (this is where your check will be sent)

Small Print *

Please type your full name in the box below to agree that you understand out terms. By typing your name, you are declaring that you understand that adopt a house is setting up a fundraising page on your behalf. We do not guarantee that the funds will be raised. Adopt A House agrees to pay you the amount raised, less fees. The fees include crowdrise.com fees and a 10% fee which will go toward Adopt A House and keeping programs such as this one possible. Adopt A House will pay by check on a monthly basis as we are paid by crowdrise.com. All donations are tax deductible and are made to Adopt A House and then allocated to the designee on a monthly basis.

Please take a moment right now to create a crowdrise.com account -- please enter your user name here so we can find you there. *

Adopt A House House #

FOR ADOPT A HOUSE USE ONLY - We have assigned a number to your house based on when you registered. This is the number we will use to identify you in this and other fundraisers.

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