Forms & Rules

Registration

Ceraland Eligible Member / Spouse Name
Address
City
State
Zip
Home Phone
Work Phone
Email

Wellness & Fitness (Choose One)

Participant Name (First & Last) CECO/ACM/Guest Program Name Session Start Date Fee Paid

Athletics (Choose One)

Participant Name (First & Last) CECO/ACM/Guest Program & Team Name Session Start Date Fee Paid

Program / Special Event (Choose One)

Participant Name (First & Last) CECO/ACM/Guest Program Name Program Date Fee Paid

Method of Payment

Check - If paying by check, please mail to Ceraland, 3989 S 525 E Columbus IN 47203
Visa/Mastercard - If paying with credit card, we will call the number you supply below to retrieve information.
Number to call for credit card information:

By submitting this form, I, the participant and/or parent or legal guardian, hereby agree to waive, release and indemnify Cummins Employees Recreation Association, Inc., its Board of Directors, Officers, Agents and Assigns from any and all claims, demands, actions or suits (including, but not limited to costs and attorney's fees), arising out of any injury, death, damage or loss which might be sustained by me, my dependants or any persons as a result of my participation in the above activities.

I agree to abide by all Rules and Regulations of the Cummins Employees Recreation Association.

Refund Policy

  • Ceraland reserves the right to cancel any class, program or league which falls below the minimum participation. A full refund will be issued in these situations.
  • A $5.00 fee will be charged to cover administrative work.
  • All refunds require a minimum of 2 – 3 weeks to process.
  • No refunds will be given after the class, program or league begins

By submitting this form I acknowledge that I have read and understand the above agreement.

Date Submitted