2020 Registration Form
2020 Marisa’s Purpose Run/ Walk 5K - Lodge Park Monticello, IL
Saturday, September 26, 2020
Packet Pick-up and Same Day Registration 7:30 – 8:15 am
Early Registration Fee On or Before July 31st: $20 per person
Early Registration is encouraged to guarantee a shirt!
Same Day Entry fee: $30 per person
Name: _____________________________Circle: Male Female Age on Race Day_______
Address: ______________________City: ____________________ State: ____ Zip Code_____
Email:______________________________ Phone: _________________
Shirt Size Adult: S M L XL 2XL
Age Bracket: 12 & under; 14 & under; 15-19; 20-24; 25-29; 30-34; 35-39; 40-44; 45-49; 50-54; 55-59; 60 & over Awards: Top three in each category and one overall Male/Female Winner
On or before July 31, 2020 $20 per person
Register at marisaspurpose.org
Or, mail completed registration form and payment to:
Connie Gyorr 362 E. 1400 North Rd. Monticello, IL 61856
Checks payable to: Marisa’s Purpose Faith, Hope, and Love
I recognize and acknowledge that there are certain risks of physical injury to participants in this event, and I voluntarily agree to assume the full risk of any injuries, damages or loss, regardless of severity that I and/or my minor child/ward may sustain as a result of participating in any and all activities connected with or associated with this activity. I further agree to waive and relinquish all claims I and/or my minor child/ward may have as a result of participating in this activity against Marisa’s Purpose FHL Non-Profit Org, and the City of Monticello, Lodge Park, the Marisa’s Purpose FHL 5K Race Committee, Race Time, Inc., and their respective sponsors, officials, agents, volunteers, elected officials, past and present board members and employees (hereinafter collectively referred to as “Parties”).
I do hereby fully release and forever discharge the Parties from any and all claims for injuries, damages or losses that I and/or my minor child/ward may have or which may accrue to me or my minor child/ward arising out of, connected with, or in any way associated with this event. I further agree that this agreement shall be governed by the law of the State of Illinois.
Race will be held rain or shine. No refunds will be issued for any reason, including injury.
By participating in this event, the Marisa’s Purpose FHL Non-Profit Org and the Marisa’s Purpose FHL Race To Recovery 5K Race Committee have the right to reproduce/use videos and photos taken of the event and participants on race day as well as posting of results from the race on the internet.
I have read and fully understand the above assumption of risk and waiver and release of all claims.
Signature (Guardian if under 18) ____________________________________________