Scrammble Games Show(Dr. Wordman Show)

An Education Project Sponsored by Concerned Community Organizations

PO Box 944, Yorktown Heights, New York 10598

Tel  914-248-6770  Fax 914-248-6429 email scrammble@scramble.us

Website  http://www.scrammble.us

Request/Release Form for Video Recording & Broadcasting

 

Players Names & Addresses

 

 

 

 

 

Email and Phone Contact

 

 

Event Date and Location

 

 

Sponsor Name If Any

 

 

Players School Names & Addresses If Any

 

 

 

Guardian Signature for given permission to video Recording & Broadcasting

Guardian Signature:

 

Player Signature (Optional):

 

Date of Event

 

____________________, Year _____

 

Release Form Received BY Name

Committee Member of Scrammble Tournament & Workshop ___________

 

Consent to Press Interview & Report

Applies to recording & broadcasting event, Guardian Initial ___________

 

Thank you for participating in the ‘Community Education- Scrammble Tournament & Scrammble Games Show’. The game show is broadcast through public TV/Cable Channels, Schedules see www.scrammble.us 

* Scrammble Tournament is a community education project to provide a fun event that stimulates good learning habit for children and family in communities

** Scrammble Games Show (nicknamed Dr. Wordman Show, no relation to Mr. Letterman Show) will be held at Cablevision Studios, details see www.scrammble.us CC: Cablevision