Fall/Winter 2025/2026

Appointment*

Name of Parent*

First NameLast Name

Let us know about your eligible children (grades K-12). Children in preschool are not eligible for services from The Clothesline. If you are shopping for more than 4 children, please make 2 back-to-back appointments. The last appointment of each day is limited to 2 children.*

	Name	Age
Child 1
Child 2
Child 3
Child 4

Let us know about your eligible children (grades K-12). Children in preschool are not eligible for services from The Clothesline. If you are shopping for more than 4 children, please make 2 back-to-back appointments. The last appointment of each day is limited to 2 children.*

	Name	Age
Child 1
Child 2

I will text a photo of one of the following to 571-354-7240 before my appointment or email a copy to contactclotheslinearl@gmail.com*

Free/reduced price lunch letter from 2025/2026 school yearReferral from school social worker or social service providerMy children attend a community eligibility school (Abingdon, Barcroft, Barrett, Campbell, Carlin Springs, Drew, Randolph, Thomas Jefferson, Kenmore or Wakefield) and I will text a screenshot of their ParentVue Class Schedule

Phone Number*

Please enter a valid phone number.

Email

example@example.com

Which method of contact do you prefer?*

Phone/textEmail

After you submit this appointment request form you will have the option to fill out a Family Intake form. If you have completed the Family Intake form in the past and there are no changes to your family or contact information you do not need to complete it again.

If you have NOT completed this form previously or there are changes to your family or contact information, please complete the form before your appointment.

Comments / Questions

The Clothesline Appointments