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                                                  2021 Marisa’s Purpose Run/Walk 5k or 11-mile Bike Ride 

                                                                    Allerton Park & Retreat Center 

                                                               515 Old Timber Road  Monticello, IL 

                                                              Saturday, September 25, 2021

                                        Packet Pick-up and Same Day Registration 7:15 – 8:00 am        

                                                        Same Day Entry fee: $30 per person

Name: _____________________________Circle: Male  Female Age on Race Day_______ 

Address: ______________________City: ____________________ State: ____ Zip Code_____  

Email:______________________________ Phone: _____________

Custom T-Shirts select size:  XS_____ S_____L______XL_____2XL_____3XL______4XL______

                                              One overall Male/Female Winner for each event 

                                                                 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, Allerton Park, the Marisa’s Purpose FHL 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 also understand and agree that I and/or my minor child/ward will wear a mask at all times when not on the race course, utilize hand sanitizing stations when needed, maintain at least 6' social distancing from other participants that are not part of my immediate family, stay home if feeling ill, and agree to temperature check.  I also understand and agree that if I, and/or my minor child/ward are creating a risk for others, we will be expected to leave the race site immediately.

Bike riders have to follow the rules of the road and it is mandatory that all riders wear a bike helmet.

I have read and fully understand the above assumption of risk and waiver and release of all claims.

Signature (Guardian if under 18) ____________________________________________