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Maypearl Independent School District

Lorene Smith Kirkpatrick Elementary School

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School Nurse

  • Health Services Forms
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  • Healthy History/Emergency Form

    Healthy History/Emergency Form

    Please complete this form upon enrollment or if there are changes to medical information or emergency contacts.

    Health History Form.pdf 130.95 KB (Last Modified on November 30, 2017)
    Comments (-1)
  • Medication Administration Form

    Medication Administration Form

    Your student's clinic will need a Medication Authorization Form for each medication kept in the clinic. If the medication is a prescription a physician's signature will be required.  Please make sure all medications are in their original containers and are not expired.  We are unable to administer expired medications.

    Medication Authorization Form.pdf 96.04 KB (Last Modified on January 7, 2019)
    Comments (-1)
  • Food and Environmental Allergy Form

    Food and Environmental Allergy Form

    If your child is allergic to any foods or environmental allergens please complete the following form. 

    Food Environmental Allergy Form.pdf 77.32 KB (Last Modified on January 11, 2019)
    Comments (-1)
  • Anaphylaxis Action Plan

    Anaphylaxis Action Plan

    If your child has been prescribed epinephren to treat allergic reactions, please have his/her physician complete this form and return it to the nurse with proper medication. 

    Anaphylaxis Action Plan.pdf 142.05 KB (Last Modified on January 7, 2019)
    Comments (-1)
  • Asthma Action Plan

    Asthma Action Plan

    If your child has been diagnosed with asthma or other airway diseases, please have his/her physician complete this form and return it to the school nurse.

    Asthma Action Plan.pdf 55.08 KB (Last Modified on January 7, 2019)
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Maypearl Independent School District

Lorene Smith Kirkpatrick Elementary School

ADDRESS: 1024 W. Fourth St., Maypearl, TX 76064

PHONE: 972-435-1010

FAX: 972-435-1011

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Maypearl ISD Mission

The mission of Maypearl ISD, a tradition-rich community, is to cultivate the unique potential of all students through innovative education.

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