August 2026 Activities Registration Form

Participant's Full Name

First NameLast Name

Participant's Date of Birth

Date

Participant's Email Address, if applicable.

example@example.com

Participant's Phone Number, if applicable.

Please enter a valid phone number.Format: (000) 000-0000.

Fitness Group - Mondays and Fridays in August, 3pm at Medina Planet Fitness. This is a self-lead activity, with authentic opportunities to socialize with group members.

Art Group - August 5 at 6pm, Medina County Board of DD

Walk and Roll - August 7 at 6pm, Plum Creek Park North, 2390 Plum Creek Parkway, Brunswick

Water Ski Show Team- August 12 at 6:45pm - PLEASE notice address 3196 Clark Mill Rd, Norton - We will meet closer to the large tree to right of main seating. We recommend bringing an umbrella to offer shade, if needed. Bring chair or blanket for seating.

Walk and Roll - August 14 at 6pm, Shotwell Gardens, 4581 Foote Rd., Medina

RoadRokr 5K/1mi - August 15 at 8am (Also, search for race link, sign up, email receipt to Lisa Morrison at info@ics-oh.org for reimbursement.)

Art Group - August 19 at 6pm, Medina County Board of DD

Game Night and Puzzle Club - August 21 at 6pm, Medina County Board of DD

Volunteer Opportunity! Help Medina Rotary with their annual 9/11 Memorial Clean Up - August 22 at 9AM, 300 West Reagan Parkway, Medina

Self Advocacy Group Health and Wellness Series - LIMITED SEATING - Exercise and Chair Yoga- Join us as we discuss the benefits of exercise, and practice a round of chair yoga with our instructor! - August 22 at 3pm, the Medina Recreation Center, 855 Weymouth Rd, Medina (We have had a problem with people signing up, and not attending. Please DO NOT do this! Please know if you sign up and do not attend, you are taking the spot of someone who really wants to be there, and we will ask you to reimburse ICS for your $15 registration fee.)

If the Self Advocacy Group is full, would you like to be on the waiting list?

Movie Club - Spider-Man: Brand New Day - August 23 at 3pm, Medina Regal Cinema

Total number attending Spider-Man; Brand New Day, INCLUDING group participant. Enter 0 if not attending

Dinner Club - August 24 at 5:30pm, Winking Lizard, 3634 Center Rd., Brunswick

If Dinner Club is full, would you like to be on the waiting list?

Volunteer Activity: Join us as we come together to meet a pressing need in our community! We are making PB&J Sandwiches for those in need - August 26 at 6pm, Buehler's Community Room, 3626 Medina Rd., Medina

Race for Glory 5K/1mi - August 29 at 9am (Also, search for race link, sign up, email receipt to Lisa Morrison at info@ics-oh.org for reimbursement.)

Please select your authority to sign this form:

Integrated Community Solutions, Inc.

Waiver, Release and Hold Harmless Agreement

I (the Participant) have been offered the opportunity to participate in and/or volunteer to help with social activities organized by Integrated Community Solutions, Inc., (ICS) a non-profit Ohio charitable corporation. I want participate in ICS programs because it gives me pleasure and satisfaction to be involved with others who are developmentally disabled, or who are family and friends of people with developmental disabilities. I fully understand and accept the risks involved in these activities.

As consideration for being provided this valuable opportunity, I will hold harmless and indemnify ICS, its directors, agents, volunteers and employees, from any and all losses, claims, actions or proceedings of every kind and character, including claims for negligence and for damages of any kind, including damage to property, personal injury or death which may arise directly or indirectly from my presence at ICS locations, and my participation in ICS activities. I agree to abide by all policies, procedures and instructions adopted by ICS as they may change from time to time.

I understand that ICS will take pictures and videos during various social engagement opportunities. I give ICS permission to use my likeness, photo, video to promote ICS, and raise funds for the organization. I understand that I will not be compensated for this. If I do not agree to this, I will discuss this with the group coordinator.

I certify that I have the legal authority selected above, have read the ICS Waiver Agreement in its entirety, understand its terms, and voluntarily agree to be legally bound by it.

Guardian's Full Name. If participant does not have an appointed Guardian, please enter participant name.

First NameLast Name

Guardian's Relationship to Participant. If participant does not have an appointed Guardian, please select Self.

Guardian's Email Address. If participant does not have an appointed Guardian, please enter participant's email, or other email we may contact.

example@example.com

Guardian's Phone Number. If participant does not have an appointed Guardian, please enter participant's phone number.

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Signature

Date

Hour MinutesAM/PM Option

You will be emailed a registration receipt, with all group selections. PLEASE CHECK JUNK FOLDER if you do not see your registration receipt in your Inbox.

ICS August 2026 Activities Registration Form

Please indicate which activities you plan to attend.