Rivermont Neighborhood Youth Soccer Clinic Registration Form

This activity is designed to strengthen ties in the Rivermont Neighborhood. Please encourage other Rivermont Neighbors to sign up. Individuals living outside the neighborhood will be welcome if space permits.

I am a Rivermont Neighbor I am not a Rivermont Neighbor but would like to participate if space allows.

Parent or Guardian Name

This address will receive a confirmation email

Phone

Address

Text is our primary form of communication. I give permission for REPC to send me text messages through Breeze. (You will receive a text later to opt in. Please reply YES.)

YES, text me as needed NO, don't text me soccer info

Child's Name

Please Select One Below

I have a Rivermont United Shirt from a past season I am in need of a Rivermont United Shirt

T-Shirt Size

Please Select One Below

I have Soccer Cleats I am in need of Soccer Cleats

Shoe Size

School

Grade in School

Second Child's Name

Please Select One Below I have a Rivermont United Shirt from a past season I am in need of a Rivermont United Shirt

T-Shirt Size

Please Select One Below I have Soccer Cleats I am in need of Soccer Cleats

Shoe Size

School

Grade in School

How did you hear about this program?

Description

September 6-October 11

DATES: Fall 2025 | September 6 - October 11

TIME: Saturdays from 10:00am to 11:00am

WHERE: Kingston Field - near the intersection of Early Street and Dinwiddie.

This activity is intended to strengthen community ties for kids living in the Rivermont neighborhood. Registrations will receive a t-shirt on a first-come, first served basis while supply lasts.

Families living outside the Rivermont Neighborhood will be welcome to play as space allows.

SPONSORS:
•Liberty University Men's Soccer Team
•LAYSI - Lynchburg Area Youth Sports Initiative
•In Rivermont, For Rivermont - Rivermont Evangelical Presbyterian Church

Rivermont Neighborhood Youth Soccer Clinic Registration Form

Description

Please Fix the Following