SAFARICOM CHAPA

DIMBA IS BACK
CHEZA KAMA WEWE!
2023 REGISTRATION FORM
 2023 ENTRY FORM
(THIS REGISTRATION FORM IS FREE)

Name of Club:……………………………………………………...................... Address of Club: ..........................................................

Region: (tick one) Western Rift Nyanza Coast Eastern N. Eastern Nairobi Central
County ............................................................................................................................................................................
Sub County: ............................................……………………………….. Venue: .........................................................................
Name of Coach: …...........................................................…………. Mobile: ........................................................................
Name of Team Manager: …........................................................... Mobile: ........................................................................
Name of Team Captain: ................................................................ Mobile: .......................................................................
Name of Secretary: ...............................................................….... Mobile: ........................................................................
Name of Chairman: ..................................................................... Mobile: .......................................................................
Colour of Uniform: .........................................................................……………………………………..…
We confirm that the above are our bona fide club officials and that we have read and accepted all terms and conditions.

TERMS AND CONDITIONS OF PARTICIPATION

1. All players must read, understand and sign the registration forms.
2. Participating teams to register 18 players for the tournament and will be allowed to replace up to 5 players after their
respective county finals.
3. All teams must adhere to the rules and regulations of the tournament. Teams flouting these rules and regulations will
automatically be disqualified from the tournament.
4. No player will play for more than one team during the preliminary stage of the tournament. All players will only play under
their registered teams. Any player switching teams after the preliminary stages must inform the organisers.
5. No Nationwide or Premier League players will be allowed to participate in the tournament.
6. All players must have been born between 1st January 2004, and 31st December 2007 (inclusive).
7. Duly filled registration forms must be submitted together with copies of either National Identity Card, Valid Passport or
School ID.
8. School ID will only apply to those below 18 years of age and must be accompanied by nemis number.
9. Clinic cards, School IDs without a stamp, Baptismal cards, School leaving certificates, National ID waiting cards are not
acceptable.
10. If non of the above documents are available then participation will be at organizer’s discretion.
11. Any player who submits a fake National ID will be guilty of a misdemeanor and will be handed over to the authorities.
12. On the day of the tournament, each player will be required to produce ORIGINALS of the photocopied identification
documents submitted with the registration form. Failure to do so will result in the player being disqualified from participating
in the tournament.
13. Teams will be responsible for their internal affairs. Disputes within the teams, that jeopardize the credibility of the tournament
may lead to automatic disqualification from the tournament.
14. Participating teams will not hold the organiser responsible for any injuries, losses or any damages during the tournament.
15. Participating teams and all their members exclusively authorize the organisers to use their teams’ name or individuals on
promotions and advertisements before, during and after tournament.
16. All players must agree to random drug tests during the duration of the entire tournament. Appropriate action will be taken by
organisers on players whose results are positive, or who will fail to show up for the test at the designated place and time.
17. Integrity - participating players and teams will not take part in any form of manipulation (by offering or attempting to offer a
bribe or by receiving or attempting to receive or seek a bribe) or unlawfully alter or influence the result or any other aspect of
a football match or competition. The organisers will have the right to expel a player(s) team from the competition that does the
contrary.
18. All players must be of good health and medically fit to participate in the tournament.
19. The organisers reserve the right to change rules of participation without prior notice. In case of any disputes arising, the
organisers decision will be final.

RULES AND REGULATIONS

1. Any player receiving a red card will be suspended for two consecutive matches.
2. Any player who receives 2 red cards during the tournament will be suspended from any further participation in the tournament
and banned from the next edition.
3. Any player who accumulates two yellow cards in successive matches will be suspended from participating in the next match.
4. Cards received during the semi-finals and finals will be carried forward to the next edition of the event.
5. Any team that fields a player not registered and approved by the organiser will be disqualified from the tournament.
6. Teams will be required to observe high standards of discipline. Any form of violence/incitement from players, officials or fans
will lead to a total ban on the team concerned.
7. Participants can only register as an ‘all-boys’ or an ‘all-girls’ team.

NAME OF TEAM MEMBERS DATE OF BIRTH I.D/NEMIS NO. SIGNATURE

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Approved by:
Team Manager ………...................................................................................... Sign: ...................................................
Team Coach: ………......................................................................................... Sign: ...................................................
FOR OFFICIAL USE ONLY
Received by: ....……………………….…..............................… Sign: ……...................………... Date: .......................................
THIS FORM MUST BE ACCOMPANIED BY PHOTOCOPIES OF EVERY PLAYERS IDENTIFICATION DOCUMENTS FOR IT TO
BE VALID
Chapa Dimba na Safaricom reserves all rights of the tournament.
FORMAT
• The tournament will be played across five stages: sub-county, county, inter-county, regional, and National level
• FIFA rules will apply. Any variations will be communicated to the teams before start of tournament
• Each team will comprise of 18 players and 2 officials for the Kick Off Tournament
• Incase of a tie the match will go straight to penalties
• All other details pertaining to format of play will be communicated at the draw
THE REFEREES DECISION WILL BE FINAL

For further information:

Call: 0719 443 440 or 0719 443 441
Alternatively, e-mail: chapadimba@safaricom.co.ke
www.safaricom.co.ke
*Terms and conditions apply