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


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 

* 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 CC: Cablevision