Register Online for the 5K Run/Walk! -OR- 1/2 MILE "FUN RUN" following the 5K

Kids 10 & Under $10.00 per child. All participants receive a medal.  (shirts not provided)

If paying by check, please fill out this pdf registration form. Make checks payable to: Peter’s Place & Mail Checks to:
Peter's Place Foundation, NFP
333 Covered Bridge Lane
Belleville, IL 62221
- OR -
you may pay online by following the prompt after submitting the form below.

PLEASE NOTE: Online registration form requires online payment. Any online registration form will be discarded if not accompanied by online payment. Last day to register online is September 25, 2018 @ Midnight

Race Day Registration is from 3:30-4:30pm only. Children 10 and under NOT PARTICIPATING in the "FUN RUN" are FREE with registered paid adult. Late registration does not guarantee a shirt. Shirts provided for paid entries only.

Personal Information
First Name*
Last Name*
Email address*
Phone Number*
Gender* Male    Female    
Age on 10/6/18*
Email address and Phone Number will not be disclosed

Participation Information
Select T-Shirt Size (Adult Sizes) XL XXL 
Participant Type Runner Walker Non-Particpant Donation 
Where did you hear about our event?

Disclaimer/Waiver of Liablility
I understand that running/walking a race is a potentially hazardous activity. I know that I should not enter a run/walk unless I am medically able and properly trained. I agree to abide by the decision of any race official relating to my ability to safely complete the race. I assume all risks associated with running/walking this event. Having read this waiver, my checking of the below box verifies that I understand these facts and understand that upon your acceptance of the application, the entry fee is non-refundable. I, myself, and anyone entitled to act on my behalf, waive and release, Peter's Place Foundation, NFP and the city of Fairview Heights, Illinois, and all other persons, sponsors, volunteers, their representatives and successors from all claims or liabilities of any kind arising from my participation in this race. I also understand that some information may be used by the sponsors. I grant permission to all the foregoing to use any photographs, motion pictures, recordings or any other record of this race for any legitimate purpose.

I have read and agree to these Terms and Conditions.