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

5K Registration $25 until Race Day

"Fun Run" for Kids 10 & Under $15.00 per child.  All participants receive a real finisher's medal.  Start time 9:30am

If paying by check, please fill out this PDF registration form. Mailed registrations must be postmarked by 9/25/19.

Make checks payable to: Peter’s Place & Mail Checks to:
Peter's Place Foundation, NFP
c/o 333 Covered Bridge Lane
Belleville, IL 62221

You may pay online by submitting the Online Registration Form below and following the prompt to pay immediately after submission.

PLEASE NOTE: Online Registration Form requires online payment at the same time as Registration.  Any online registration form will be discarded if not accompanied by online payment.  Last day to register online is September 25, 2019 @ Midnight

Registrations received after 9/15 will NOT be guaranteed a shirt.

Race Day Registration is from 7:00 - 8:00am 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*
Street*
City*
State*
Zip*
Email address*
Phone Number*
Gender* Male    Female    
Age on 10/5/19*
Email address and Phone Number will not be disclosed

Participation Information
Select T-Shirt Size (Adult Sizes)



XL 
XXL 

Participant Type

Runner 
Walker 
Kids 1/2 Mile Fun Run 
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.