Shelby County Sheriff's Women's Safety Registration

Thank you for your interest in the Shelby County Sheriff's Women's Self-Defense Course.

To attend one of our courses, you MUST fill out all required information in the below form. The form is submitted securely to the Sheriff's Office.

* Denotes Required Fields

Course Date and Time: 4/18/2026 8:00 AM-4:00 PM

Do you agree to a background check?

Yes

Do you have a criminal record?

Yes

If Yes, Please Explain... 500 characters or less

Are you at least 18 years old?

Yes

Are you a legal resident?

Yes

First Name

Middle Name

Last Name

Preferred Name

Email Address

Phone

Work Phone

Date of Birth

Mailing Address

Check if same as mailing address

Physical Address

Driver's License Number

Driver's License Expiration Date

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