Admission Office: (703) 971-8004

Admission/School Office: (703) 971-8004

Parents Resources From Calvary Road Christian School

2022 Medication Authorization 2022

If you don’t want to submit the form online you can click the link below to download the file and submit to our school.

For Prescription and Non-prescription Medications VDSS Division of Licensing Programs Model Form INSTRUCTIONS:

  1. Section A must be completed by the parent/guardian for ALL medication authorizations.

  2. Section A and Section B must be completed for any long-term medication authorizations (those lasting longer than 10 working days). In order to submit section B, you must download the form and take it to your physician to be signed.

Section A: To be completed by parent/guardian

Medication Authorization
CRCS trained staff members have permission to administer the following medication *
Check here to indicate agreement
This signed form is valid for 10 school days from the submission date

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