Hi there! As far as I can tell, there isn't one. It seems to simply be a letter from the doctor. The daycare can still refuse to let her in due to being a "risk" for others. Sucks, but that's what I've been circling to.
Here is the form
an affadavit is on the form already...just have it signed
and i think cali parents have to undergo a 'talk' from the dr about vaccines, prior to exemption
“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines.” - Marcia Angell, M.D., former NEJM Editor Private Parts are Private Property!
It's the form that emmy526 gave you. Sign the back, (second page), and check boxes A and E on the front. If you don't want your child to get the TB test injection, also sign that part on the back. I've never heard of a daycare or school in California not accepting a child because of an exemption, but just in case, wait until your child is accepted into the daycare before giving them the exemption.
The form will change in January 2014, requiring a doctor or nurse's signature that they have discussed the benefits and risks of vaccines with you. But you won't need to do that if your child is already in the daycare. Just when she goes to a new one or a new school.